REACH-OUT: Research, Engagement and Action on COVID-19 Health Outcomes via Testing

As the coronavirus disease 2019 (COVID-19) pandemic evolved, equitable access to SARS-CoV testing and contact tracing was critical to ongoing pandemic surveillance. Even as COVID-19 infection rates, hospitalizations, and deaths were declining overall, testing was necessary to identify people who may benefit from COVID-19 therapies, to encourage isolation and quarantine of close contacts to prevent spread, to monitor for real-world vaccine effectiveness, and to learn about how the virus may be spreading within communities. For those communities disproportionately affected by COVID-19, testing may be simultaneously more important and yet more challenging because of the social, ethical, and behavioral implications (SEBI) of a positive test. Fears of positive tests leading to lost wages, employment disruption, privacy breaches, or housing instability can deter testing and contact tracing. In some communities, structural barriers, mistrust, or other factors may have contributed to vaccine hesitancy or lower rates of vaccination - circumstances that create greater potential for bias, discrimination, and stigmatization of communities where future COVID-19 outbreaks or may occur. The goal of REACH-OUT (Research, Engagement and Action on COVID-19 Health Outcomes via Testing) was to improve the reach, uptake and sustainability of COVID-19 testing among 5 underserved and socially- or medically-vulnerable populations via a community-based, participatory action research approach. The project built upon the strong community engagement network infrastructure built by the Colorado Community Engagement Alliance Against COVID-19 Disparities (CO-CEAL) and an existing Phase I SEBI grant (CONCERTS; Community Organizations for Natives: COVID-19 Epidemiology, Research, Testing, and Services). It broadened and deepened these efforts to address the next phase of the pandemic. This unique partnership between communities and multidisciplinary academic researchers with expertise in bioethics, mixed methods research, intervention design, and public health evaluation: (1) engaged communities to rapidly understand key cultural beliefs, communication preferences, and community-level resources that can be leveraged to overcome social, ethical, and behavioral barrier to COVID-19 testing using mixed methods; (2) co-created and implemented a menu of culturally-concordant strategies at the individual, interpersonal, health system, and/or community levels to increase testing rates, contact tracing, and access to COVID-19 support services using an Intervention Mapping approach; and (3) evaluated the processes and testing outcomes from REACH-OUT to inform the COVID-19 response and responses to future pandemics (including evaluation of the engagement process itself). The study focused on 5 populations (American Indian/Alaska Native; Urban LatinX; Rural LatinX; Urban Black or African American; and Black/Refugee), enabling the team to draw comparative insights about the barriers in common and unique to each and - in coordination with other SEBI projects - to generalize the findings to other communities throughout the US.