The health and economic effects of the COVID-19 pandemic in the United States are staggering, and persons of color in the US ? already heavily impacted by structural inequities ? bear a disproportionate burden of COVID-19 disease and death. Testing is a cornerstone of stopping the spread of the virus, yet in the US testing rates remain far below target levels and current strategies are failing to reach the communities most affected. In California, despite initial success in limiting spread with the earliest shelter-in-place mandate in the nation, even partial attempts at easing restrictions have resulted in a surge in new cases. Currently, California has the highest case count in the U.S and the pandemic is taking a disproportionate toll on Latinx individuals, many of whom are essential workers. An incomplete understanding of testing barriers and optimal strategies to mitigate these barriers among Latinx persons hampers the design of the scalable strategies needed to accelerate equity in the reach, uptake, and preventative impact of SARS CoV-2 testing throughout the US. In this proposal, our objective is to evaluate community-engaged approaches to scale low-barrier COVID-19 testing for Latinx communities and evaluate retesting strategies for priority groups in Latinx communities at increased risk of infection. We will draw upon our experience with Latinx community-engaged mass SARS- CoV2 testing campaigns, expertise in community-based HIV testing trials informed by behavioral economics and the success of San Francisco?s Latinx Task Force for COVID-19 model.
In Aim 1, we will evaluate implementation of a Latino Task Force (LTF) collaborative network across 3 counties in Northern California (Marin, Merced and San Francisco), adapted from San Francisco?s LTF model to promote locally-adapted COVID-19 test and respond initiatives in two majority-Latinx communities: one suburban (Marin) and one rural (Merced).
In Aim 2, we will determine the population-level prevalence of active (PCR+) SARS-CoV-2 infection, most at-risk subgroups, and attitudes and preferences of community members regarding COVID-19 testing services during baseline mass testing campaigns at the Marin and Merced sites. The campaigns will offer testing to all community residents regardless of symptoms at easily accessible venues, implemented in partnership with each site?s LTF.
In Aim 3, we will conduct a 3-arm randomized controlled trial (RCT) to determine the comparative effectiveness of two behavioral strategies ? one that leverages incentives (extrinsic motivation) and another that relies on altruism framing (intrinsic motivation) compared to standard offer of retesting (control) ? to increase frequent SARS-CoV-2 retesting among most at-risk sub-groups (identified during Aim 2 campaigns) within the study communities. The proposed research will provide critical data to inform scalable testing strategies, reduce transmission, decrease health disparities, and set the stage for future, biomedical interventions, such as vaccines.

Public Health Relevance

The COVID-19 pandemic is having devastating health and economic effects globally and disproportionately affecting Latinx/Hispanic and Black/African American communities across the US that were already heavily impacted by health inequities prior to the pandemic. This study aims to implement and evaluate community- engaged approaches to improving access and uptake of COVID-19 testing in Latinx communities in Northern California, and understanding local epidemiology and factors driving the stark ethnic disparities observed in COVID-19 case rates.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Center Core Grants (P30)
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Special Emphasis Panel (ZAG1)
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Refsland, Eric William
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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