Optimization of a new adaptive intervention to increase COVID-19 testing among people at high risk in an urban community

Project SummaryCOVID-19 has disproportionately impacted medically or socially vulnerable populations in marginalized urbancommunities across the United States (e.g., people with co-morbidities, working in high risk settings, thoserefusing or unable to adhere to the State of New Jersey (NJ) prevention guidelines). Social determinants ofhealth (SDH) such as stigma, incarceration, and poverty are associated with increased exposure to COVID-19and increased deaths. In the absence of effective, potent, and widely available vaccines and treatments,prevention - i.e., testing, social distancing, contact tracing, and quarantine -- is essential. Little is known aboutacceptability of COVID-19 testing in low-income and racial/ethnic minority neighborhoods, where residentsexperience increased barriers to prevention (e.g., inadequate housing, high-risk jobs). However, we haveknowledge of cost-effective, evidence-based, and culturally appropriate interventions that have beensuccessfully used to engage people in HIV prevention and treatment. These interventions can be adapted andtested to help address COVID-19. Navigation services (NS) increase HIV testing and adherence to treatmentwhile addressing structural barriers that deter treatment engagement in high-risk communities. Brief counselingincreases HIV treatment engagement. This study uses a Sequential, Multiple Assignment Randomized Trial(SMART) with 582 COVID-19 medically/socially vulnerable people. Guided by the COVID-19 Continuum ofPrevention, Care, and Treatment, analysis will explore factors associated with testing and adherence to publichealth recommendations. The study aims include: Aim 1: To optimize an adaptive intervention that willincrease rates of testing and adherence to NJ COVID-19 recommendations (testing, social distancing,quarantine, hospitalization, contact tracing and acceptance of COVID-19 vaccination) among high-riskpopulations. Aim 2: To identify predictors of testing completion and adherence to NJ recommendations.This study is innovative in its application of existing evidence-based interventions to address COVID-19 andthe use of SMART following Community Based Participatory Research principles. It has