Culturally-targeted communication to promote SARS-CoV-2 antibody testing in saliva: Enabling evaluation of inflammatory pathways in COVID-19 racial disparities

Project Summary African Americans develop and die from SARS-CoV-2 infection more than any other racial group in the United States, including in majority African American cities such as Flint, Michigan. SARS-CoV-2 disparities stem from many interconnected causes. Yet, connections to inflammatory biological processes in COVID-19 disparities remain largely unknown. Evaluating inflammatory responses can be facilitated by SARS-CoV-2 antibody testing, which can be used to identify and compare inflammation among those with and without confirmed SARS-CoV-2 infection, and to conduct cross-race comparisons of inflammatory factors. However, African Americans will be reluctant to partake in conventional antibody testing programs due to medical mistrust and experiences with racism that are salient in the COVID-19 era. There is thus an urgent need to develop and deploy culturally-relevant communication and antibody testing programs. Our long-term goal is to identify and reduce unjust COVID-19 racial disparities. The immediate objective is to better encourage understanding and uptake of SARS-CoV-2 antibody testing. The central hypothesis is that African-Americans will be receptive to antibody testing when benefits and limitations are communicated in a culturally effective manner, and when non-invasive salivary collection methods and assays are used. Our rationale is that combining culturally effective health communication with salivary testing will reduce mistrust and promote uptake that can lead to better grasping the role of inflammation in COVID-19 disparities. Our aims are to 1) develop and compare effects of a general versus culturally-targeted video about antibody testing on African American and White Flint residents' antibody testing attitudes and uptake; 2) identify and compare effects of a general versus culturally- targeted video on activation of medical mistrust and racism-related cognition among African Americans when considering antibody testing; 3) measure and identify multi-analyte inflammatory biomarker profiles among Flint Registry enrollees who complete salivary antibody testing and compare inflammatory biomarker profiles by race and antibody status. In collaboration with clinical and community partners, we will prepare and evaluate general and culturally-targeted video tutorials about SARS-CoV-2 antibody testing. These brief videos will be distributed to the Flint community through the Flint Registry - a highly visible local health resource exchange. In collaboration with leading salivary bioscience experts, we will furnish an opportunity to engage in at-home salivary antibody screening - a non-invasive route to antibody testing that is highly suited to disparities- oriented COVID-19 research. The proposed research is innovative and significant in highlighting that culturally- targeted communication and non-invasive antibody testing are vital to propelling disparities-oriented inflammatory COVID-19 research. Knowledge to be gained includes video tutorials and insights about community-facing salivary collection that can be immediately disseminated across SeroNet to better promote including racial monitories in ongoing studies of inflammation and antibody testing.