Improving COVID-19 Vaccine Uptake Among Racial and Ethnic Minority Groupswith Rheumatic Diseases

PROJECT SUMMARY Black and Latinx individuals are at higher risk for certain autoimmune rheumatic diseases (AIRDs) and have experienced worse COVID-19 outcomes compared to their white counterparts. The American College of Rheumatology recommends beyond the initial COVID-19 vaccination, subsequent COVID-19 vaccine doses to complete the primary vaccination series and a booster dose in people with AIRD. Yet, historically, overall vaccine uptake among people with AIRDs has been low, and this vaccine reluctance has extended to COVID- 19 vaccination. This proposal will harness community-engaged methods to develop and test the effectiveness of a multi-modal intervention that combines "storytelling" videos and patient navigation to increase uptake of recommended COVID-19 vaccination among Black and Latinx AIRD patients in two distinct US geographic regions. Aim 1 will develop a multi-modal intervention that includes a) "storytelling" videos we will produce with vaccinated Black or Latinx patients with AIRDs narrating their COVID-19 vaccination experiences, and b) a patient navigation approach to encourage recommended COVID-19 vaccination. Navigators will be trained using virtual case simulation to discuss up-to-date guidance and provide logistical support for vaccination. In Aim 2a we will recruit 1,170 racial and ethnic minority patients from 4 rheumatology clinics in the Southern and Northeastern U.S. to participate in this patient-level, randomized, controlled, parallel group trial. Participants will be randomized to receive at the routine clinic visit either "storytelling" OR an "attention-control" plus usual care. At the clinic visit, coordinators will invite participants to view "storytelling" videos on tablet computers deployed in a private clinic area. At 2 days after the clinic visit, the navigators will contact each participant remotely (phone/video calls) to provide customized assistance for vaccination. A second contact will occur ~2 weeks later. We will examine the differences in rates of COVID-19 vaccine receipt between racial/ethnic minority participants with AIRD exposed to our multi-modal intervention versus an "attention-control" video (focused on the merits of a balanced diet/exercise on health status) plus usual care. We will measure rates of receipt of subsequent COVID-19 vaccination at 3 months after the clinic visit using extant linkages to state vaccination records (primary endpoint). We will measure via surveys COVID-19 vaccine confidence, influenza vaccine uptake (self-report) as a proxy for intervention effect on vaccination behavior for other vaccines, self- efficacy, and social health. We will explore whether insurance status and education moderate COVID-19 vaccine uptake. In Aim 2b, using surveys and semi-structured interviews, we will assess how intervention components achieved their effects to inform future scale-up of our intervention. Beyond our innovative approach and experienced team, a key strength of our study is its generalizability since we are including two geographically distinct regions with substantial ethnic/racial diversity in their populations that deliver care to many uninsured, Medicaid, and other historically marginalized groups.