Alabama is ranked as the state most vulnerable to COVID-19 by the community vulnerability index, and among the bottom 5 states in meeting SARS-CoV-2 testing targets. COVID-19 case rates are 3-fold higher in several rural counties in Alabama relative to metropolitan areas like Birmingham, with SARS-CoV-2 testing percent positivity approaching or exceeding 20% in a majority of rural counties. Meaningful community engagement in developing and implementing SARS-CoV-2 testing programs is vital to proactively address social, ethical and behavioral considerations germane to underserved communities. University of Alabama at Birmingham (UAB) Center for AIDS Research (CFAR) investigators have long-standing relationships working with clinical, community, and public health agencies to conduct innovative HIV testing and prevention studies, and are poised to act swiftly in response to the COVID-19 pandemic. A Dynamic COVID-19 Community-Engaged Testing Strategy in Alabama (COVID COMET AL) will transfer vast community-informed HIV testing knowledge to address the urgent need for rapid scale-up of SARS-CoV-2 testing among underserved rural, socio-economically disadvantaged, and Black/African American populations. COVID COMET AL is grounded in the ADAPT framework for tailoring evidence-based public health interventions for new settings and populations, and includes Assessment, Preparation, and Implementation phases. In collaboration with well-established clinical and community testing partners, regional health education centers, and additional community-based organizations, CFAR investigators will work together with interdisciplinary scientists from across campus at UAB to conduct the following specific aims:
Aim 1 (Assessment): Refine a data-driven, time-updated algorithm to identify the underserved rural counties most impacted by COVID-19 in Alabama, Aim 2 (Preparation): Use a community- engaged sequential mixed-methods approach to inform tailored adaptation and implementation of the COVID COMET AL strategy in highly impacted rural counties selected for implementation, Aim 3 (Implementation): Deploy the iteratively adapted COVID COMET AL strategy, which includes peer health advocates, community health workers, and venue based testing, in 3 highly impacted rural Alabama counties at a time, in two sequential waves, each lasting 6-months, and Aim 4: Evaluate the implementation process of COVID COMET AL in partnering with community stakeholders to maximize program reach, effectiveness, and sustainability. Using a quasi-experimental, paired, comparative time series study design, temporal change in SARS-CoV-2 testing percent positivity will be compared in the 6 implementation counties relative to 6 matched control counties as the primary outcome, with testing reach, time to return test results, and time to contact tracing as secondary outcomes. Evaluation of COVID COMET AL implementation grounded in the Interactive Systems Framework will inform dissemination of this dynamic, data-driven public health testing strategy to maximize impact in addressing disparities in underserved rural communities, and will also guide COVID-19 vaccination strategies.
In the United States, the burden COVID-19 is increasingly concentrated in the South, with states like Alabama experiencing high rates of infections along with inadequate testing. Impoverished rural counties in the South have been particularly impacted, with socioeconomically disadvantaged and Black/African American communities hit hardest. The Dynamic COVID-19 Community-Engaged Testing Strategy in Alabama (COVID COMET AL) project will evaluate the success of a new, community-engaged, rapid scale-up testing strategy in reducing the disproportionate burden of COVID-19 in underserved rural counties.
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