Rapid Optimization of COVID-19 Testing for People Affected by Diabetes

The Georgia Center for Diabetes Translation Research Center (P30DK111024) proposed to leverage its interdisciplinary expertise (clinicians, implementation and behavioral scientists, public health, technology, and diabetes experts) and collaborations (community, academic, government, and health system partners) to rapidly scale a COVID-19 testing program for adults and children who are at high risk due to background metabolic disease (i.e., diabetes, obesity, or elevated risk of diabetes). The Rapid Optimization of COVID-19 Testing for People Affected by Diabetes program adapted, optimized, and iteratively evaluated and refined a testing and education strategy delivered through the network of Federally-Qualified Health Center (FQHC) partners. This study focused on Georgia, a national epicenter of diabetes, which is experiencing rapidly escalating COVID-19 cases, morbidity, and mortality. Yet, the state has not accelerated testing opportunities, leaving critically underserved subgroups at high-risk without access to testing. Building on technologies and innovations designed by the team, this study addressed access gaps, optimized resource allocation to meet high risk groups where it suits them best, and supported people at the time of and after their test results. Guided by the EPIS framework, the implementation program learned how to scale the strategy, combining approaches to reach high-risk groups through testing enhancement at FQHC partner sites and other community testing centers with a "test your bubble" approach to provide opportunities for all household members to get tested. To achieve this, geospatial analyses were conducted to identify localities of testing deserts within counties with high densities of people at risk for COVID-19 infection, hospitalization, and mortality (Aim 1; Exploration); engage community and clinic stakeholders to formatively understand what barriers and facilitators influence testing and what strategies are well-received by users (Aim 2; Preparation); develop models that provide real-time guidance on whom to test, where to test, and when to test (Aim 3; Preparation); and deploy and evaluate the program at testing site partners using rapid-cycle testing in a pre-post effectiveness-implementation type 2 hybrid study (Aim 4; Implementation). Sustainability will be measured through continuous quality improvement efforts (Aims 2, 4) and future research. Data from this study motivated further programs and studies of how to scale serological testing and vaccination (in the future) and has huge relevance for underserved areas of other states. The study evaluated this program in terms of its reach, effectiveness, adoption, implementation, and maintenance (REAIM). The team had extensive experience applying these transformative innovations to reach populations. The project team leveraged partnerships with the Georgia Department of Public Health, nationally-recognized expertise via the NIH-funded Rapid Acceleration of Diagnostics Validation Core at Emory University, National COVID-19 Resiliency Network at Morehouse's School of Medicine, and the Georgia Clinical and Translation Science Alliance's Community Engagement Program.