Leveraging Bio-Cultural Mechanisms to Maximize the Impact of Multi-Level Preventable Disease Interventions with Southwest Populations

Title: Eliminating COVID-19 disparities in Arizona in partnership with underserved/vulnerablecommunitiesAbstract Arizona has one of the highest COVID-19 positivity test rates (approximately 19%) in the U.S. Positivityrates are disproportionally higher among Arizona's Latinx, American Indian and African American communities.The proposed community driven and culturally congruent intervention aims to increase access to testing byidentifying and decreasing barriers to testing in vulnerable and underserved communities across Arizona. Theintervention aims at reducing disparities in COVID-19 diagnostics, education, wraparound services andreferrals to a primary care provider, with the ultimate goal of improving the health of underserved communities.The proposed approach empowers local communities, meets community members where they are, is datadriven, and creates the infrastructure for continued community-driven delivery of care. Following a Community Based Participatory Research (CBPR) orientation, the project will: (a) identifyand prioritize testing deserts, (b) coordinate testing at different levels of the social ecosystem, (c) engage andtrain local Community Health Workers (CHWs) deliver saliva-based COVID-19 testing to vulnerable andunderserved community members, (d) deliver test results within 72 hours, (e) provide wrap-around servicesand provider referrals for those testing positive, and (f) sustain the intervention during a follow-up period. Equality Health Foundation serves as the lead community partner and convener of a growing COVID-19 Coalition of Communities of Color Partners (CCCCP) from across Arizona. The ASU Biodesign ClinicalTesting Laboratory (ABCTL) will provide the saliva-based SARS-CoV-2 molecular diagnostic. The saliva test'smain benefits are: a) minimal to no PPE requirements compared to nasopharyngeal (NP) swabs; b)convenience and economy of specimen collection; c) ease of repeat sampling; d) administration by minimallytrained CHWs and e) greater sensitivity and consistency of saliva tests than NP swabs. The project aims toadminister 29,000 saliva tests, 10,000-12,000 at identified testing deserts during the launching period, doublingthe numbers during the follow-up period in Year 1, and adding 5,000 tests in Year 2. A longitudinal evaluationwill assess the intervention's impact by comparing randomly selected participants in the R.A.P.I.D. interventionduring the launching period (N=500) with a matched comparison group (N=500) randomly selected fromstandard testing sites. ASU's existing NIMHD-funded U54 Specialized Center of Excellence (RFA-MD-17-005;5U54MD002316-14) with its Community Advisory Board and in collaboration with key government, communityorganizations, tribal governments and academic partners is well equipped and eligible to undertake theproposed revision. The aims of this emergency competitive revision match and enhance the aims of the currentU54 award and the assembled transdisciplinary team has the infrastructure, capacity, and communitypartnerships in place to implement the project.