Leveraging Social Networks to Increase COVID-19 Testing Uptake: A Comparison of Credible Messenger and Chain Referral Recruitment Approaches

Until the advent of treatment or a vaccine, our ability to contain COVID-19 must rely on widespreadidentification of (asymptomatic) positive cases, their subsequent quarantine, and contact tracing of thosepotentially exposed. Therefore testing efforts must be targeted to those highly vulnerable yet unservedpopulations, including individuals who use opioids and other substances. These individuals may have poorrespiratory or pulmonary health due to substance use (e.g. opioids, methamphetamine), which may make themmore susceptible to the virus. Also, these individuals are also more likely to have been incarcerated, or resideon the street, in shelters or in crowded accommodation, further placing them at risk for transmission. Wepropose research to establish efficacy and sustainability of a community-social network outreach model thatpartners infectious disease health providers with community based organizations to successfully implement(reach, uptake, delivery and sustainment) COVID-19 point of service, rapid-testing among a highly vulnerableand often underserved population, those who use opioids and other substances. Two distinct social networkrecruitment strategies with demonstrated efficacy identifying hidden populations and increasing uptake of HIVtesting will be adapted and compared. Guided by the EPIS framework, social cognitive theory, and Andersen'smodel, this study comprises three phases. Phase 1: Adaptation of outreach recruitment strategies, we willwork with our project community advisory board (CAB) to adapt chain-referral and credible messenger strategiesfor uptake of COVID-19 testing, to finalize recruitment and on-site testing protocols, and to train the CAB in thenew protocols and in continuous quality improvement strategies (Aim 1). Phase 2: Strategy Efficacy Trial andImplementation Evaluation, we will compare the two strategies in a cross-over design at two community basedorganizations (CBOs) with long standing history of serving hard-to-reach populations in their communities. Thecomparison of strategies is not to identify the statistical superiority of one sampling strategy in providingpopulation estimates over the other, but instead to identify the ability of each recruitment strategy to reach thetarget population and increase uptake of COVID-19 tests. We will examine the impact of each strategy on (i)reach (recruitment of target population), (ii) COVID-19 testing/repeat testing, and (iii) service delivery (i.e.quarantine, medical care and contact tracing) among those who test positive for COVID-19 (exploratory) (Aim2). Phase 3: Sustainment, CBOs will implement the strategy proven efficacious based on outcomes, and wewill examine their sustainment of the program (Aim 2). Implementation evaluation will identify participant-, staff-,and organizational-level factors that influence the feasibility, acceptability, and sustainability of each strategy inthese CBOs. (Aim 3). This investigation will provide much needed information to improve health outcomes and toidentify effective system-level responses to prevent or arrest the spread of COVID-19 among the social networksof those who use opioids and other substances, a highly vulnerable and often overlooked population.