Developing novel strategies to increase COVID-19 testing among underserved and vulnerable populations in West Virginia through community and state partnerships

West Virginia (WV) is rated by Becker's Hospital Review as the state with the sixth most vulnerable populationto the novel coronavirus (SARS CoV-2) while a second group at Wallethub, using three key domains (medical,housing, financial), rates WV as the most vulnerable state to SARS CoV-2 impact. Central to the state's extremevulnerability is the high prevalence of obesity, cardiovascular disease including hypertension, chronic lungdisease due to smoking and environmental exposure (e.g., mining), diabetes mellitus, and cancer. Additionally,WV is among the three states having the highest proportion of persons > age 65 years (20%). Through schooland university closures in March 2020, along with shutdown of non-essential businesses, WV had relatively fewCOVID-19 cases and deaths until July 2020 when transmissibility (Rt) skyrocketed. Testing remains problematicin WV for multiple reasons, including inadequate testing supplies, accessibility to testing sites (given the ruralityof the state and lack of widespread public transportation), shortages of personal protective equipment for staff,and lack of insurance coverage for surveillance testing and for uninsured persons. The West Virginia Clinicaland Translational Science Institute (WVCTSI) is submitting this application in partnership with multipleorganizations with which they have existing collaborative relationships, including: 1) the WV Practice BasedResearch Network (PBRN), a 107 site primary care network spanning the state, 2) the WV Department of Healthand Human Resources, 3) the WV National Guard, 4) West Virginia University (WVU) Health Sciences Centerand College of Engineering, and 5) the Partnership of African American Churches (PAAC). Critically importantis the generous match of $1.5 MM that the state of WV is offering to this initiative should this supplement receivefunding. Vulnerable populations addressed in the application include individuals in rural communities and AfricanAmerican populations as well as those with comorbidities known to increase risk of severe COVID-19. Given thehigh prevalence of substance use disorder (SUD) in WV, a cross-cutting theme is ensuring persons with SUDare included in all proposed strategies to increase SARS CoV-2 testing. We will address COVID-19 testingdisparities through achievement of the following specific aims, all of which use nucleic acid polymerase chainreaction testing on nasal or nasopharyngeal swabs: 1) Enhance COVID-19 testing among rural primary careoffices located across WV, 2) Intensify COVID-19 testing through mobile vans in areas forecasted to experiencea near-term increase in COVID-19 incidence, and 3) Increase COVID-19 testing in Black or African Americancommunities through a dedicated mobile van and home testing. Evaluation of implemented strategies includesassessing numbers of tests performed, uptake of home testing, satisfaction surveys, and structured interviewsamong Black or African Americans enrolled in the home testing study.