A Dynamic COVID-19 Community-Engaged Testing Strategy in Alabama (COVID COMET AL)

This study seeks to understand the factors associated with COVID-19 morbidity and mortality disparities and to lay the foundation to reduce disparities for those underserved and vulnerable populations that are disproportionately affected by, have the highest infection rates of, and/or are most at risk for adverse outcomes from the COVID-19 pandemic. This implementation study assesses the modality and venue preferences for COVID 19 testing in rural, incarcerated, and other underserved populations in the state of Alabama. The objective of the study is to evaluate the implementation of a rapid scale-up SARS CoV-2 testing strategy. The original goal of the study was to conduct 30,000 tests in rural counties statewide.

In Aim 1, we defined higher case burden as counties with more than 25 daily cases of COVID-19 per 100,000 total population and lower case burden as less than 10 daily cases per 100,000, both using a 7-day average. In order to identify communities particularly vulnerable to morbidity and disease spread we mapped age, race, income, education based on census data; and the COVID vulnerability index which includes social determinants of health as well as data regarding healthcare access, and COVID-19 disease risk factors. We also mapped areas where mitigation efforts are particularly poor via cell phone movement and a surrogate measure of belief in COVID-19 science and public policy recommendations. These data were used to work with community partners to prioritize rural counties for testing delivery. All analyses used publicly available aggregate data and did not enroll individuals. As such, these Aim 1 data will not be transmitted to the CDCC.

For Aim 2, we have partnered with a third-party survey vendor to collect the full battery of Tier 1 Common Data Elements (CDEs) required for the project. The survey sample (n~300) will be a representative sample of the rural populations from various counties in which the tests were administered. This data will be uploaded to the CDCC including all required CDEs.
For Aim 3, in collaboration with community partners, specifically the Alabama Area Health Education Centers (AHEC), we administered COVID-19 tests within underserved rural populations statewide. All told from 10/01/20 until 02/28/22, we administered over 23,000 PCR tests, which resulted in a 12% positivity rate. This included testing with the Visby point-of-care PCR test developed via RADx-TECH, which had particular uptake in rural jails across Alabama. In accordance with DHHS reporting requirements, we collected basic demographic data from all those who were tested, including race, gender, and age. As approved by NIH, this limited dataset will be provided for all persons tested via this project, but not all CDEs, as testing was done as standard of care and not for research purposes.

Aim 4 of the study will evaluate the effectiveness of the testing initiative’s implementation strategy, which will be completed by June 2022. We want to know how appropriate and feasible the testing initiative has been for those involved. The target population for this aim of the study are researchers, administrators, and testing staff who have been involved in the project, and will not include the general population and communities offered testing services. As such, there is no individual-level data capture aligned with the CDCC CDE model. We have collected over 100 surveys and plan on conducting 50 in-depth interviews for this aim. We plan to publish scholarly reports to enhance communities’ abilities to implement wide-spread testing initiatives. These data are not included in the RADxUp Hub. Please, reach out to Michael Mugavero at [e-mail] or Larry Hearld at lhearld @uab.edu for more information about these data.