Rapid Optimization of COVID-19 Testing for People Affected by Diabetes

PROJECT SUMMARY/Abstract: The Georgia Center for Diabetes Translation Research (P30DK111024) proposes to leverage its interdisciplinaryexpertise (clinicians, implementation and behavioral scientists, public health, technology, and diabetes experts)and collaborations (community, academic, government, and health system partners) to rapidly scale a COVID-19testing program for adults and children who are at high risk due to background metabolic disease (i.e., diabetes,obesity, or elevated risk of diabetes). The "Rapid Optimization of COVID-19 Testing for People Affected byDiabetes" program will adapt, optimize, and iteratively evaluate and refine a testing and education strategydelivered through our network of Federally-Qualified Health Center (FQHC) partners. We focus on Georgia, anational epicenter of diabetes, which is experiencing rapidly escalating COVID-19 cases, morbidity, and mortality.Yet, the state has not accelerated testing opportunities, leaving critically underserved subgroups at high-riskwithout access to testing. Building on technologies and innovations designed by this team, we will addressaccess gaps, optimize resource allocation to meet high risk groups where it suits them best, and support peopleat the time of and after their test results. Guided by the EPIS framework, our implementation program will learnhow to scale the strategy, combining approaches to reach high-risk groups through testing enhancement atFQHC partner sites and other community testing centers with a "test your bubble" approach to provideopportunities for all household members to get tested. To achieve this, we will conduct geospatial analyses toidentify localities of "testing deserts" within counties with high densities of people at risk for COVID-19 infection,hospitalization, and mortality (Aim 1; Exploration); engage community and clinic stakeholders to formativelyunderstand what barriers and facilitators influence testing and what strategies are well-received by users (Aim 2;Preparation); develop models that provide real-time guidance on whom to test, where to test, and when to test(Aim 3; Preparation); and deploy and evaluate the program at testing site partners using rapid-cycle testing in apre-post effectiveness-implementation type 2 hybrid study (Aim 4; Implementation). Sustainability will bemeasured through continuous quality improvement efforts (Aims 2, 4) and future research. Data from this studywill motivate further programs and studies of how to scale serological testing and vaccination (in the future) andhas huge relevance for underserved areas of other states. We will evaluate this program in terms of its reach,effectiveness, adoption, implementation, and maintenance (REAIM). We have extensive experience applyingthese transformative innovations to reach populations. We will leverage partnerships with the GeorgiaDepartment of Public Health, nationally-recognized expertise via the NIH-funded Rapid Acceleration ofDiagnostics Validation Core at Emory University, National COVID-19 Resiliency Network at Morehouse's Schoolof Medicine, and the Georgia Clinical and Translation Science Alliance's Community Engagement Program.