COVID-19 has disproportionately impacted medically or socially vulnerable populations in marginalized urban communities across the United States (e.g., people with co-morbidities, working in high risk settings, those refusing or unable to adhere to the State of New Jersey (NJ) prevention guidelines). Social determinants of health (SDH) such as stigma, incarceration, and poverty are associated with increased exposure to COVID-19 and increased deaths. In the absence of effective, potent, and widely available vaccines and treatments, prevention ? i.e., testing, social distancing, contact tracing, and quarantine -- is essential. Little is known about acceptability of COVID-19 testing in low-income and racial/ethnic minority neighborhoods, where residents experience increased barriers to prevention (e.g., inadequate housing, high-risk jobs). However, we have knowledge of cost-effective, evidence-based, and culturally appropriate interventions that have been successfully used to engage people in HIV prevention and treatment. These interventions can be adapted and tested to help address COVID-19. Navigation services (NS) increase HIV testing and adherence to treatment while addressing structural barriers that deter treatment engagement in high-risk communities. Brief counseling increases HIV treatment engagement. This study uses a Sequential, Multiple Assignment Randomized Trial (SMART) with 582 COVID-19 medically/socially vulnerable people. Guided by the COVID-19 Continuum of Prevention, Care, and Treatment, analysis will explore factors associated with testing and adherence to public health recommendations. The study aims include:
Aim 1 : To optimize an adaptive intervention that will increase rates of testing and adherence to NJ COVID-19 recommendations (testing, social distancing, quarantine, hospitalization, contact tracing and acceptance of COVID-19 vaccination) among high-risk populations.
Aim 2 : To identify predictors of testing completion and adherence to NJ recommendations. This study is innovative in its application of existing evidence-based interventions to address COVID-19 and the use of SMART following Community Based Participatory Research principles. It has

Public Health Relevance

Little is known about the acceptability of COVID-19 testing in low-income and racial/ethnic minority neighborhoods, where residents experience increased barriers to prevention and treatment (e.g., unstable housing, higher risk jobs). In this study, community members and researchers will work together as partners with a community-based organization to test an intervention to increase COVID-19 testing and adherence to science-based COVID-19 treatment and prevention recommendations. The study will also produce in-depth qualitative data identifying ways to overcome barriers for those who do not accept testing or adhere to NJ COVID-19 recommendations.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZMD1)
Program Officer
Alvidrez, Jennifer L
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Illinois Urbana-Champaign
Schools of Social Welfare/Work
United States
Zip Code