Community Driven Approach to Mitigate COVID-19 Disparities in Hawaii's Vulnerable Populations

The long-term goal of this proposal is to eliminate COVID-19 disparities among Hawaii's racial/ethnically diverse yet vulnerable populations including Native Hawaiian and other Pacific Islanders (NHPI) living in rural and underserved communities by integrating innovative SARS-CoV-2 testing capacity with novel community-specific messaging and education. Compounded by long-standing health disparities and socioeconomic challenges, NHPIs suffer from increased infection and mortality rates attributed to COVID-19. To date, NHPIs rank among the highest disproportionately burdened by SARS-CoV-2 in the U.S. With the nation's highest Rt, a basic reproductive metric indicating the degree of viral spread, Hawaii's disaggregated NHPI data reveal further disparities. Preliminary testing data collected by our partner, the Waianae Coast Comprehensive Health Center (WCCHC), Hawaii's largest federally funded community health center, indicates a significant deficiency in testing uptake, especially among Pacific Islanders. Further, we observed under-representative coverage of testing among youth (ages 5-19 years old) in NHPI communities, despite their higher than average infection rate. Other factors, including slow testing turnaround time and untested asymptomatic cases, complicate efforts to contain further community spread. Given the looming public health concerns around the re-opening businesses and schools, these gaps highlight the critical need for innovative approaches to effecting behavioral change coupled with novel testing strategies to enhance access to all community members, including school-aged children/youth. Fortunately, our partnerships in Hawaii's culturally diverse populations offer a unique opportunity to augment the current COVID-19 response with community knowledge and resilience. We propose the hypothesis that community-contextualized messaging disseminated by novel healthcare-school partnerships coupled with a robust community and patient-centered testing strategy will increase reach, access, update, and impact for COVID-19 testing in vulnerable populations. To test this hypothesis, our multidisciplinary team aims to (1) evaluate SARS-CoV-2 testing data, identify gaps and barriers in testing, and augment community testing capacity to increase uptake and (2) optimize and implement community-informed COVID-19 messaging and education with a novel community healthcare-school network partnership in the NHPI population across Hawaii. Building on our parent "Ola HAWAII" grant, this project leverages our existing Community Engagement, Biostatistics, and Administrative Cores with the NHIP partnerships to augment the RADx-UP Coordinating and Data Collection Center for common evaluation metrics on COVID-19 testing-related outcomes and implementation. This will lay the foundation for an engaged community network primed for disseminating anticipated vaccines in Hawaii's highest risk populations. Given the urgency to both improve public health safety and re-opening schools, results from this project may offer insights into an integrated model or toolkit from which health clinics and schools in underserved & vulnerable communities across the country might actively participate in abating this pandemic.