Community Organizations for Natives: COVID-19 Epidemiology, Research, Testing, and Services (CONCERTS)

Abstract: As the COVID-19 pandemic spreads to every corner of the US, the plight of urban American Indian/AlaskaNative (AI/AN) people is often overlooked or ignored. SARS-CoV-2 and the disease it causes, COVID-19,disproportionately affect AI/ANs, who are at highest risk of any US racial or ethnic group for developing severedisease and dying from COVID-19. Sadly, we have no data on infection rates, morbidity, or mortality on urbanAI/ANs, who comprise 71% of the total AI/AN population. Urban AI/ANs may obtain clinical care through UrbanIndian Health Programs (UIHPs), the Indian Health Service, tribal, public, and private facilities. Our discussionswith UIHP leaders reveal complex barriers to testing, such as inability to procure test kits, reach homeboundpatients, and inadequate staffing for outreach. To increase SARS-CoV-2 testing among urban AI/ANs, we willdraw on a nationwide network of Satellite Centers (all led by AI/AN scholars) established in 6 large NIH-sponsored initiatives that reach, engage, and ensure participation of community stakeholders in research at thelocal level. Our Satellite Centers will partner with 6 geographically contiguous UIHPs across the US to launchthe "Community Organizations for Natives: COVID-19 Epidemiology, Research, Testing, and Services" study(CONCERTS). The goal of CONCERTS is to remove barriers and increase SARS-CoV testing among urbanAI/ANs. First, we will use data from these 6 UIHPs to estimate current uptake of SAR-CoV-2 testing and theburden of COVID-19 disease. Second, we will survey clinic administrators, providers, and 600 patients acrossall 6 UIHPs to understand testing barriers and promoters, and preferred testing options. Third, informed bythese data, the 6 UIHPs will implement locally tailored clinic-associated (e.g., drive-through, mobile unit-basedtesting) and outreach-based strategies (e.g., COVID-19 navigators) to increase SAR-CoV-2 testing. After 1year, we will re-examine testing rates for a pre-post comparison to establish if these strategies weresuccessful. Fourth, we will collaborate with the UIHPs to produce a list of sustainable, pragmatic practices forfuture pandemics and vaccination programs. Our primary outcome is the monthly testing rate for SARS-CoV among urban AI/ANs. The Specific Aims are to: 1) Estimate baseline SARS-CoV-2 testing and infectionrates to identify disparities in testing and disease burden in urban AI/ANs; 2) Survey administrators, providers,and 100 patients from each of 6 UIHPs to identify barriers, facilitators, attitudes, risk factors, and necessaryservices pertinent to SARS-CoV-2 testing; 3) Implement clinic-associated and outreach-based strategies ateach UIHP to increase testing rates and reduce spread of SARS-CoV-2, then compare testing rates before andafter implementation; and 4) Evaluate CONCERTS and catalog pragmatic practices for application to futurepandemics and successful vaccination campaigns among urban AI/ANs. The nation's efforts in AI/AN healthcare have been described as a "historic failure." This history continues during the current pandemic,underscoring the urgent needs of facilities serving America's "largest tribe" - urban AI/ANs.