Transforming Community Engagement to Increase SARS-CoV-2 Testing in Underserved Populations in Baton Rouge (TEST UP-BR)

In the US, COVID-19 has unveiled a disproportionate health burden in low income and underserved segments of society. In Louisiana, some of the greatest health and economic consequences are evident in Black communities. There was an urgent need to establish effective testing strategies in these communities as the Fall/Winter virus surges unfolded. The Louisiana Clinical and Translational Science (LA CaTS) Center provided the essential infrastructure and key foundational support for biomedical research in this region; it was uniquely positioned to lead a community-engaged testing research project to determine differences in COVID-19 testing rates between community-based (churches, community centers, and schools) and medical clinic-based testing sites, and determine approaches that would increase uptake of testing in underserved Black communities in the South. These issues were addressed using a two-pronged approach. First, a community based participatory research approach was applied to determine differences in SARS-CoV-2 testing rates across distinct types of test sites within five urban underserved Black communities in the American South. A multimedia campaign was used to promote and conduct real-time reverse transcription polymerase chain reaction (RT-PCR) testing on salivary samples obtained from 2,000-3,000 adults at 1) medical clinics, 2) schools, 3) community centers, and 4) churches (in random order) within five ZIP codes with known low socioeconomic status (SES) and a high representation of Black residents. The primary outcome was the number of tests performed at each type of test site. Information on age, sex, race, height, weight, employment, and household income, etc. was collected to identify important correlates of testing rates. Second, the strong and well-integrated partnership with the Baton Rouge Mayor's Healthy City Initiative (HealthyBR) was further leveraged together with the LA CaTS Community Advisory Boards (CABs) to conduct community-based focus groups, to obtain qualitative data about the perceptions and attitudes related to testing access and potential barriers affecting such. This information was used to determine community-driven approaches that are effective in reducing barriers and to create strategies to increase SARS-CoV-2 testing uptake in urban underserved Black communities. Results of this project greatly increased understanding of the factors that have led to a disproportionate COVID-19 health burden in these underserved populations and lay the groundwork for developing strategies to reduce these disparities in all underserved Black communities. Resulting data informed the equitable deployment of future virus/flu testing and a SARS-CoV-2 vaccine.

在美国，新冠疫情（COVID-19）暴露了低收入及服务匮乏社会群体所承受的不成比例的健康负担。在路易斯安那州，非裔社区尤为凸显出最为严重的健康与经济后果。随着秋冬季节新冠病毒感染潮再度来袭，此类社区亟需建立行之有效的检测策略。路易斯安那临床与转化科学中心（Louisiana Clinical and Translational Science Center, LA CaTS）为该地区的生物医学研究提供了必要的基础设施与核心基础支持，其具备得天独厚的牵头条件，得以开展一项面向社区的检测研究项目：旨在对比社区型检测点（教堂、社区中心与学校）与医疗诊所型检测点的新冠（COVID-19）检测率差异，并探索能够提升美国南部服务匮乏非裔社区检测参与率的可行方案。本项目采用双管齐下的研究策略以解决上述问题。首先，本研究采用社区参与式研究方法，针对美国南部5个城市服务匮乏的非裔社区，对比不同类型检测点的严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）检测率差异。研究团队通过多媒体宣传活动，在5个社会经济地位（socioeconomic status, SES）较低、非裔居民占比高的邮政编码区域内，针对2000至3000名成年人开展唾液样本的实时逆转录聚合酶链反应（real-time reverse transcription polymerase chain reaction, RT-PCR）检测，检测点按随机顺序涵盖四类场所：1）医疗诊所、2）学校、3）社区中心、4）教堂。本研究的主要结局指标为各类检测点的完成检测人次。研究同时收集了受试者的年龄、性别、种族、身高、体重、就业状况及家庭收入等信息，以明确影响检测率的关键关联因素。其次，研究团队进一步强化与巴吞鲁日市长健康城市倡议（Baton Rouge Mayor's Healthy City Initiative, HealthyBR）以及LA CaTS社区咨询委员会（Community Advisory Boards, CABs）的紧密协作伙伴关系，开展基于社区的焦点小组访谈，以获取关于检测可及性认知、态度以及潜在阻碍因素的质性数据。上述质性信息将用于梳理能够有效降低检测阻碍的社区主导方案，并制定提升城市服务匮乏非裔社区SARS-CoV-2检测参与率的相关策略。本项目的研究结果大幅加深了我们对造成此类服务匮乏群体不成比例承受新冠（COVID-19）健康负担的相关因素的认知，并为制定可缩小所有服务匮乏非裔社区健康差距的策略奠定了基础。本项目产生的数据将为未来病毒/流感检测及SARS-CoV-2疫苗的公平部署提供决策依据。