Investigating the effectiveness of COVID-19 testing choices, community engagement, and culturally-embedded mHealth literacy delivery in a medically-underserved, community-based sample

Since the first U.S. cases were identified in Washington on January 20th and soon thereafter in Chicagoon January 24th, COVID-19 has rapidly emerged as the most prevalent and deadly respiratory infection withinthe State of Illinois, with 220,178 total confirmed cases and 7,880 (3.6%) deaths. The UIC Hospital and HealthCare System (UI Health), in collaboration with its 14 partnering Federally Qualified Mile Square Heath Centerpractice sites (FQHCs) (where this project will be implemented), saw over 4,000 of these cases between Marchand June, 2020 (6), noting the disproportionately higher rates if COVID-19 in Latinx people (47.1% with 32.7%of deaths) and in people identifying as African American or Black (28.9% with 43.1% of deaths). Of 48,111 casesreported in Cook County alone, 7,231 (15.0%) were hospitalized with 2,234 (4.6%) in an intensive care unit.These COVID-19-related morbidity and mortality disparities are accompanied by numerous other healthdisparities. Many of our FQHCs lack the staffing and revenue to test on-site and provide extensive follow-upoutpatient care for the large influxes of symptomatic patients concerned about COVID-19. These challengeshave likely resulted in increased COVID-19-related complications and deaths that might have been preventedwith clearer and more accurate public messaging about COVID-19, wider access to testing, earlier diagnosis,and an increased perception that care is confidential, accessible, and self-driven. This project will employsentinel and community-based epidemiological surveillance and participatory research methods to evaluatewhether a person-centered, rapid COVID-19 testing intervention (at-home swab and send, or on-site point ofcare testing), coupled with a novel mHealth COVID-19 Literacy and Outreach Suite of apps and videos, willserve to increase the acceptance, access, reach, uptake, and impact of COVID-19 testing at UI Health and in the14 FQHC practice sites and their corresponding catchment areas. We will also analyze the social, ethical,economic, and behavioral drivers and consequences of our outreach and testing approaches according to thedegree to which participants contribute to the co-creation of study-related messaging. Finally, we will leverageour existing infrastructures to expand testing uptake and analyze (by PCR) viral load at infection onset/exposure and following onset/exposure to determine viral dynamics and identify individuals at early andlate stages of infection. PhenX measures will be used to test intervention effects on testing and retesting uptake, time-to-diagnosis, COVID-19 knowledge, healthcare access and seeking, disclosure, medical adherence,and practice of home self-isolation, quarantine, and other infection control behaviors. All data acquisition,collection and curation approaches will be informed by the CDCC, including AboutML-informed consentapproaches and with the other RADxUP studies and relevant federal agencies.