Local health departments are employing widely varying approaches to address the dramatic health inequities associated with the COVID-19 pandemic. Learning collaboratives have been effective in other settings for bringing entities together to support joint problem solving and reduce variance in approach. These collaboratives build upon shared experiences to help their members understand not only what to do but how to do it, providing knowledge and skills that are critical to successful implementation of interventions. This study aims to examine the effectiveness of a diverse, regional learning collaborative of health departments that will rapidly adapt, test, and implement community-driven solutions for COVID testing disparities using a pragmatic, hybrid type II trial design. Based on preliminary data from a community-led approach developed in a severely affected Kansas county (Wyandotte), the project will build Local Heath Equity Action Teams in 10 counties (4 urban and 6 rural) disproportionately affected by COVID and provide them with the training and resources needed to achieve COVID testing equity. These Local Health Equity Action Teams will come together into a multi-jurisdictional learning collaborative or `Community Partner Program' (Aim 1) that can share best practices and collaborate on developing, testing and evaluating multi-component intervention packages for addressing COVID. Initial supported interventions will include: community-sponsored pop-up testing events; home-based and worksite testing; community-informed communication strategies; and `support packages' for at-risk individuals and families receiving testing. Additional interventions developed or proposed by our local community partners or identified through national RADx-UP efforts will be continuously considered by the collaborative. Working with the local Action teams, we will conduct a series of semi-structured interviews and surveys within each local community (Aim 2) to better understand common and subgroup (racial, ethnic, geographic, etc.) barriers to and facilitators of testing. We will leverage existing epidemiologic surveillance tools to develop and track a series of county-level metrics of COVID testing inequities. Guided by the RE-AIM framework and the Consolidated Framework for Intervention Research, we will examine the effectiveness (Aim 3) of the collaborative in improving uptake of COVID testing in vulnerable communities and examine the reach, adoption, implementation and maintenance of intervention components within each local community. This study will not only advance our understanding of how to achieve COVID testing equity but will also provide a framework for supporting underserved communities as they respond to future public health emergencies and COVID vaccination challenges.
As the first level of response to the Covid epidemic, local health departments can play a major role in mitigating the health disparities associated with Covid-19. This study will examine and contrast rural, urban, racial and ethnic barriers to Covid testing and see how a `learning collaborative' can help local community groups in 10 counties rapidly adapt, adopt, and implement a multi-component intervention to improve Covid testing and reduce Covid-related health disparities.
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