Collaborative community networks to optimize implementation of low barrier COVID-19 testing efforts among diverse Latinx populations in Northern California

Project SummaryThe health and economic effects of the COVID-19 pandemic in the United States are staggering, and personsof color in the US - already heavily impacted by structural inequities - bear a disproportionate burden ofCOVID-19 disease and death. Testing is a cornerstone of stopping the spread of the virus, yet in the UStesting rates remain far below target levels and current strategies are failing to reach the communities mostaffected. In California, despite initial success in limiting spread with the earliest shelter-in-place mandate in thenation, even partial attempts at easing restrictions have resulted in a surge in new cases. Currently, Californiahas the highest case count in the U.S and the pandemic is taking a disproportionate toll on Latinx individuals,many of whom are essential workers. An incomplete understanding of testing barriers and optimal strategies tomitigate these barriers among Latinx persons hampers the design of the scalable strategies needed toaccelerate equity in the reach, uptake, and preventative impact of SARS CoV-2 testing throughout the US.In this proposal, our objective is to evaluate community-engaged approaches to scale low-barrier COVID-19testing for Latinx communities and evaluate retesting strategies for priority groups in Latinx communities atincreased risk of infection. We will draw upon our experience with Latinx community-engaged mass SARS-CoV2 testing campaigns, expertise in community-based HIV testing trials informed by behavioral economicsand the success of San Francisco's Latinx Task Force for COVID-19 model. In Aim 1, we will evaluateimplementation of a Latino Task Force (LTF) collaborative network across 3 counties in Northern California(Marin, Merced and San Francisco), adapted from San Francisco's LTF model to promote locally-adaptedCOVID-19 test and respond initiatives in two majority-Latinx communities: one suburban (Marin) and one rural(Merced). In Aim 2, we will determine the population-level prevalence of active (PCR+) SARS-CoV-2 infection,most at-risk subgroups, and attitudes and preferences of community members regarding COVID-19 testingservices during baseline mass testing campaigns at the Marin and Merced sites. The campaigns will offertesting to all community residents regardless of symptoms at easily accessible venues, implemented inpartnership with each site's LTF. In Aim 3, we will conduct a 3-arm randomized controlled trial (RCT) todetermine the comparative effectiveness of two behavioral strategies - one that leverages incentives (extrinsicmotivation) and another that relies on altruism framing (intrinsic motivation) compared to standard offer ofretesting (control) - to increase frequent SARS-CoV-2 retesting among most at-risk sub-groups (identifiedduring Aim 2 campaigns) within the study communities. The proposed research will provide critical data toinform scalable testing strategies, reduce transmission, decrease health disparities, and set the stage forfuture, biomedical interventions, such as vaccines.