Determinants and Outcomes of Nicotine Metabolite Ratio in HIV + Smokers

Project Summary COVID-19, the disease caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), hasled to a global pandemic and has exacerbated existing health inequities among vulnerable populations.Despite higher rates of COVID-19 in Black and Latinx individuals compared to White individuals, rates oftesting in predominately non-White, low-income communities are significantly lower than in high-income areas.Strategies to increase COVID-19 testing rates in underserved populations are thus urgently needed. Self-testing, where individuals collect their own samples, is now feasible for the detection of SARS-CoV-2.Self-testing can increase testing convenience and privacy and has been effectively leveraged to expand testingfor other infections, such as HIV, in key populations across a broad spectrum of contexts. However, self-testingmay be limited to those with access to health services, without reaching individuals underserved by existingmedical systems. One promising approach to increase test uptake is the secondary distribution of self-testingkits, where an individual distributes tests to contacts in their social network and encourages them to self-test. Asignificant advantage of a secondary distribution strategy is that by decentralizing a health care process,individuals may be more likely to access services if delivered by social network peers, rather than healthprofessionals. In addition, secondary distribution can enhance contact tracing efforts, as individuals diagnosedwith COVID-19 can distribute self-tests to close contacts to identify additional cases. Given high levels of COVID-19 misinformation, stigma, and medical mistrust among vulnerable populations, this peer-driven test distribution strategy holds significant promise in increasing the reach of COVID-19 testing among underservedpopulations. In collaboration with our community-based partner, Public Health Management Corporation, we willconduct a 1:1 randomized trial with 1048 individuals cared for at Federally Qualified Health Centers to evaluatewhether secondary distribution of SARS-CoV-2 self-tests increases test uptake compared with referrals amongunderserved populations in Philadelphia (Aim 1). We will also assess whether the secondary distribution ofself-tests to close contacts among individuals with COVID-19 facilitates case detection (Aim 2). Additionally,we will use a mixed methods strategy to identify key social, ethical, economic, and behavioral barriers andfacilitators to secondary distribution to inform its future modifications, implementation, and scale-up (Aim 3).We will engage our relationship with community partners to reach underserved individuals with housing instability, immigrants, and those with significant medical comorbidities including HIV, viral hepatitis, andsubstance use disorders, in order to increase COVID-19 test uptake in these populations. As more rapid anduser-friendly diagnostic tests emerge, this secondary distribution model may become even more impactful. Theproposed project may establish a new paradigm for expanding COVID-19 testing and contact tracing.