RAD-X UP NARCH Supplement: A Cherokee Nation Community-Driven Program for Testing and Contact Tracing (Cherokee PROTECT)

PROJECT Summary: Through the RADx-UP program, the Cherokee Nation Community-Driven Program for Testing and Contact Tracing (Cherokee PROTECT) unites tribal, academic, and community partners under the leadership of Cherokee Nation (CN) to solve a dire need for COVID-19 testing, contact tracing, and culturally informed education in underserved and vulnerable rural populations. As of August 4, Cherokee Nation Health Services (CNHS) has confirmed >850 cases of COVID-19 in the tribal populations served across mainly rural northeastern Oklahoma. Community spread of COVID-19 exists throughout all 14 counties in the CN reservation, but with CN's limited capacity for community testing, screening, and contact tracing, the true impact of COVID-19 is unknown. Roughly 34% of American Indian/Alaska Native (AI/AN) adults aged 18-64 years are at risk of severe COVID-19 due to comorbidities, more than any other racial/ethnic group in the US.Five counties in CN are in the top 20% of US counties for the prevalence of adults at risk of severe COVID-19due to underlying medical conditions; this vulnerability is compounded by high poverty rates and geographic barriers. People living in rural areas of CN may have to travel as many as 60 miles round-trip for viral testing.Most COVID-19 testing in CN to date has been conducted through CNHS, the largest tribally compacted health system in the US that serves all AI/AN people living within the CN reservation. Although CNHS accounts for approximately 8.5% of all IHS active user population and 38% of active user population of Oklahoma service area, not all tribal members residing in the reservation access CNHS, and therefore, may not be tested by CNHS. Other than CNHS clinics, 7 of 14 counties in this area have only one public testing site, and results maynot be returned for 2-3 weeks. CNHS and its closely integrated CN Public Health program have an exemplary 20-year record of delivering public health interventions, including a groundbreaking Hepatitis C Virus elimination program with the University of Oklahoma Health Sciences Center, and ongoing projects with >40 rural K-12 schools. Through collaborative clinical research and molecular studies, CN and the OklahomaMedical Research Foundation have identified new immune biomarkers in tribal populations. Drawing on these existing strengths and infrastructure, Cherokee PROTECT will (1) Build infrastructure and increase FDA-EUACOVID-19 viral and antibody testing for clinical care in CNHS; (2) Enable community-based COVID-19 testing, contact tracing, and education with CN Public Health; (3) Identify barriers and facilitators to COVID-19 testing in the CN reservation to inform a tailored educational campaign to increase testing and contact tracing, and decrease spread; and (4) Implement a rigorous evaluation to ensure quality improvement and sustainability.