The Georgia Center for Diabetes Translation Research (P30DK111024) proposes to leverage its interdisciplinary expertise (clinicians, implementation and behavioral scientists, public health, technology, and diabetes experts) and collaborations (community, academic, government, and health system partners) to rapidly scale a COVID-19 testing program for adults and children who are at high risk due to background metabolic disease (i.e., diabetes, obesity, or elevated risk of diabetes). The ?Rapid Optimization of COVID-19 Testing for People Affected by Diabetes? program will adapt, optimize, and iteratively evaluate and refine a testing and education strategy delivered through our network of Federally-Qualified Health Center (FQHC) partners. We focus on Georgia, a national epicenter of diabetes, which is experiencing rapidly escalating COVID-19 cases, morbidity, and mortality. Yet, the state has not accelerated testing opportunities, leaving critically underserved subgroups at high-risk without access to testing. Building on technologies and innovations designed by this team, we will address access gaps, optimize resource allocation to meet high risk groups where it suits them best, and support people at the time of and after their test results. Guided by the EPIS framework, our implementation program will learn how to scale the strategy, combining approaches to reach high-risk groups through testing enhancement at FQHC partner sites and other community testing centers with a ?test your bubble? approach to provide opportunities for all household members to get tested. To achieve this, we will conduct geospatial analyses to identify localities of ?testing deserts? within counties with high densities of people at risk for COVID-19 infection, hospitalization, and mortality (Aim 1; Exploration); engage community and clinic stakeholders to formatively understand what barriers and facilitators influence testing and what strategies are well-received by users (Aim 2; Preparation); develop models that provide real-time guidance on whom to test, where to test, and when to test (Aim 3; Preparation); and deploy and evaluate the program at testing site partners using rapid-cycle testing in a pre-post effectiveness-implementation type 2 hybrid study (Aim 4; Implementation). Sustainability will be measured through continuous quality improvement efforts (Aims 2, 4) and future research. Data from this study will motivate further programs and studies of how to scale serological testing and vaccination (in the future) and has huge relevance for underserved areas of other states. We will evaluate this program in terms of its reach, effectiveness, adoption, implementation, and maintenance (REAIM). We have extensive experience applying these transformative innovations to reach populations. We will leverage partnerships with the Georgia Department of Public Health, nationally-recognized expertise via the NIH-funded Rapid Acceleration of Diagnostics Validation Core at Emory University, National COVID-19 Resiliency Network at Morehouse?s School of Medicine, and the Georgia Clinical and Translation Science Alliance?s Community Engagement Program.
Nationally, deficient access to SARS-CoV-2 testing has been slowing our efforts to identify and support those at highest risk of COVID-19 illness and death from protecting themselves and their families. To close this testing access gap and lack of follow-up thereafter, our team will build on its established record of supporting communities and clinics in low- resource settings to successfully accelerate testing and treatments, especially in people with diabetes or risk factors like obesity or high blood pressure. We will rapidly adapt and evaluate whether and how our testing and education strategy facilitates testing for 100,000 people, identify at least 10,000 high-risk people and their household members in areas of Georgia with low rates of testing and engage them in prevention, and optimize the state?s resources to slow the pandemic?s impacts.
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