Community-Engaged Research to Improve the COVID-19 Testing Cascade Among Underserved Populations in the US Caribbean Territories

SARS-CoV-2, the virus that causes COVID-19, has ravaged underserved and vulnerable populations in the US, including in the US territories of Puerto Rico (PR) and the US Virgin Islands (USVI). Pre-pandemic
data from our Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) (NIH/NIMHD U24MD006938; Pl: Nunez-Smith) indicate nearly 61 % of our population-based representative
sample (n=3000) has at least one chronic condition making them high risk far severe complications from COVID-19.4 Nearly 30% of ECS participants report food insecurity.These ECS data were recenlly
requested by the Congressional Ways and Means Committee to scope the threat of the COV1D-19 pandemic to the Caribbean US territories. This competitive revision leverages the Yale Transdisciplinary
Collaborative Center for Haallh Disparities Research focused on Precision Medicine (Yale-TCC; NIH/NIMHD U54MD010711; MPI: Nunez-Smith), which supports broader scientific engagement across ECHORN
members. ECHORN was founded in 2011 as a consortium of researchers and non-academic stakeholder partners, using a participatory action research approach, to address the epidemic of non-communicable
diseases in the region. The Yale-TCC is a community-engaged and stakeholder-driven network with a consortium comprised of 60 individuals representing 35 organizations, spanning academia, research, health
policy, faith-based organizations, community-based organizations, and civic societies. The Yale-TCC Governing Board guides prjoritization.
The goal of the proposed community-engaged research is to, in concert with the RADx-UP consortium. understand factors that have led to the disproportionate disease burden and deploy interventions that
improve the reach, access, uptake and impact of COVID-19 testing technologies and strategies across FQHCs, local CBOs, and clinical laboratories in the USVl and PR. We use rigorous quasi-experimental
designs to evaluate the proposed testing inten/ention projects. This will be achieved through the following specific aims:
Aim 1: Enhance testing implementation strategies in the USVI and PR utilizing community-based assets and cultural responsiveness to address barriers to full participation in the testing continuum from diagnosis
through to seif-isolation. We propose an initial partnership with 3 FQHCs (two in USVI and one in PR) and 2 CBOs (one in USVI and one in PR) to refine and implement a multi-component Jnten/ention to increase
testing, contact tracing, and safe and effective quarantine and isolation, with a focus on the most vulnerable populations. We use an interrupted time series study design to analyze the effect of our intervention on
the primary implementation outcome of reach. We assess secondary Implementation outcomes of adoption, fidelity, acceptability, and sustainability. We also assess the secondary effectiveness outaome of ER
utilization. We engage our community partners throughout the inten/ention refinement, implementation, and evaluation process.
Aim 2: Assess the diffusion and uptake of FDA authorized and approved testing technologies across existing and emerging testing models. Through stakeholder and community engagement meetings, we will
determine inten/ention components that provide the necessary education/health promotion information, training, and resources that are needed to address barriers at the FQHC, CBO, and community-levei to
adopt, implement, and disseminate new testing technologies. Sustalnability of this model for integralion of future technologies or vaccines will be addressed and assessed.