African Americans (AA) are disproportionately burdened by COVID19 across the spectrum of related cases, hospitalizations, and deaths compared to Whites. Many multilayered barriers increase risk for COVID19 among AA including poverty, essential jobs with increased virus exposure, cultural norms (eg, risk denial, medical/contact tracing mistrust), and limited access to healthcare and other services/resources. These barriers highlight the need for accessible, trusted COVID19 testing and linkage to care (LTC) services (eg, health, prevention programs, community resources, contact tracing) to help slow COVID19 spread in AA communities. The AA church is an institution with extensive influence in AA communities and may be an ideal setting for increasing reach of COVID19 testing and LTC in hard hit AA communities. Yet, no controlled AA church-based studies exist on COVID19 testing interventions. The primary aim of this study is to fully test a culturally/religiously-tailored, church-based COVID19 testing and LTC intervention condition against a non- tailored intervention condition on COVID19 testing rates at 6 months with adult AA church members and the community members they serve. Churches will be matched on membership size, denomination and past participation in church health intervention studies, then randomized to treatment condition. Sixteen churches (8 churches/arm; 45 church and 15 community members/church; N=960 total) will participate in the study. LTC use, contact tracing approval, and COVID19 prevention behaviors will also be examined at 6 months as secondary outcomes. Guided by the Theory of Planned Behavior and Socioecological Model, our community- engaged approach includes trained church leaders delivering a culturally, church-appropriate COVID19 Toolkit inclusive of digital tools: a) individual self-help materials and tailored text messages; b) in-person/virtual group seminars for caregivers of persons with COVID19; c) in-person/virtual church services with COVID19 related materials/activities (e.g., sermons, testimonials, responsive readings); and d) church-community level LTC services (eg, insurance, healthcare, prevention programs, community resources, contact tracing) provided virtually by community health workers, church-community-based re-opening guidelines, and church-based COVID19 testing events with health agencies. Examination of LTC use and contact tracing approval will aid in understanding intervention impact on COVID19 testing by addressing participant essential needs. Potential mediators/moderators related to receipt of COVID-19 testing will be evaluated, and a process evaluation to determine implementation facilitators, barriers, and fidelity related to increasing COVID19 testing rates. Our ongoing meetings with our long-term faith and health partners is enabling us to quickly adapt our AA church- based HIV testing and diabetes prevention interventions for the proposed study. This multilevel study could provide an effective, scalable model for increasing COVID19 testing, prevention, and LTC/contact tracing approval with AA churches in partnership with health agencies, and provide strategies to streamline delivery/uptake of future COVID-19 vaccination.
This 2-arm clustered, randomized community trial will test a multilevel, COVID-19 testing and linkage to care (eg, health insurance, medical appointments, community resources, contact tracing) intervention against a nontailored, attention-control condition on uptake of COVID-19 testing with adult African American church- affiliated members at 6 months. Contact tracing approval (beliefs and participation contact tracing) and COVID19 prevention behaviors will also be examined. Findings from this study could provide a theory-based, multilevel model for delivering scalable, wide-reaching COVID-19 testing and linkage to care services, including contact tracing, by supporting African American faith leaders with culturally-appropriate, easy-to-use tools and health agency partnerships.
