Leveraging Bio-Cultural Mechanisms to Maximize the Impact of Multi-Level Preventable Disease Interventions with Southwest Populations

Arizona has one of the highest COVID-19 positivity test rates (approximately 19%) in the U.S. Positivity rates are disproportionately higher among Arizona's Latinx, American Indian and African American communities. The following community-driven and culturally congruent intervention aims to increase access to testing by identifying and decreasing barriers to testing in vulnerable and underserved communities across Arizona. The intervention aims at reducing disparities in COVID-19 diagnostics, education, wraparound services and referrals to a primary care provider, with the ultimate goal of improving the health of underserved communities. This approach empowers local communities, meets community members where they are, is data driven, and creates the infrastructure for continued community-driven delivery of care. Following a Community Based Participatory Research (CBPR) orientation, this project: (a) identified and prioritized testing deserts, (b) coordinated testing at different levels of the social ecosystem, (c) engaged and trained local Community Health Workers (CHWs) to deliver saliva-based COVID-19 testing to vulnerable and underserved community members, (d) delivered test results within 72 hours, (e) provided wrap-around services and provider referrals for those testing positive, and (f) sustained the intervention during a follow-up period. EHF serves as the lead community partner and convener of a growing COVID- 19 Coalition of Communities of Color Partners (CCCCP) from across Arizona. The ASU Biodesign Clinical Testing Laboratory (ABCTL) provided the saliva-based SARS-CoV-1 molecular diagnostic. The saliva test's main benefits are: a) minimal to no PPE requirements compared to nasopharyngeal (NP) swabs; b) convenience and economy of specimen collection; c) ease of repeat sampling; d) administration by minimally trained CHWs, and e) greater sensitivity and consistency of saliva tests than NP swabs. Under this project, 29,000 saliva tests were administered, 10,000-12,000 at identified testing deserts during the launching period, doubling the numbers during the follow-up period in Year 1, and 5,000 tests were added in Year 2. A longitudinal evaluation assessed the intervention's impact by comparing randomly selected participants in the R.A.P.I.D. intervention during the launching period (N=500) with a matched comparison group (N=500) randomly selected from standard testing sites.