Leveraging Social Networks to Increase COVID-19 Testing Uptake: A Comparison of Credible Messenger and Chain Referral Recruitment Approaches

Background: The purpose of this study was to determine the efficacy and sustainability of a community-social network outreach model that partnered infectious disease health providers with community-based organizations to implement COVID-19 point-of-service rapid testing among individuals who used opioids and other substances. This population was at increased risk for COVID-19 due to poor respiratory health, incarceration, homelessness, and crowded living conditions.

Materials/Methods: This longitudinal cohort study compared two social network recruitment strategies adapted from HIV testing models to improve COVID-19 testing among hard-to-reach populations. Guided by the EPIS framework, social cognitive theory, and Andersen's model, the study was conducted in three phases. In Phase 1, recruitment strategies were refined with input from a community advisory board, which also received training in continuous quality improvement. In Phase 2, a cross-over efficacy trial at two community-based organizations compared the strategies on reach, testing uptake, and service delivery, including quarantine, medical care, and contact tracing. In Phase 3, the most effective strategy was implemented and evaluated for feasibility, acceptability, and sustainability. Data collection included antigen and PCR testing, interviews, focus groups, and surveys with primarily adult participants who were African American, Hispanic or Latino, homeless, incarcerated, or of lower socioeconomic status.

Outcome/Impact: This study provided critical information to improve health outcomes and identify effective system-level responses to prevent or contain the spread of COVID-19 among social networks of people who use opioids and other substances. The intended impact was to determine which recruitment strategies most effectively increased testing uptake and to develop sustainable, community-driven approaches for reaching underserved and highly vulnerable populations.