The Cherokee Nation Community-Driven Program for Testing and Contact Tracing (Cherokee PROTECT)

The Cherokee Nation Community-Driven Program for Testing and Contact Tracing (Cherokee PROTECT) united tribal, academic, and community partners under the\nleadership of the Cherokee Nation (CN) to solve a dire need for COVID-19 testing, contact tracing, and culturally informed education in underserved and vulnerable rural\npopulations. From the beginning of the pandemic to November 15, 2021, Cherokee Nation Health Services (CNHS) had identified 24,314 confirmed cases of COVID-19 and 283 active cases at the time of study (which were tracked) in the tribal populations served across mainly rural Northeastern Oklahoma. Community spread of COVID-19 exists throughout all 14 counties in CN Reservation, but with limited capacity for community testing, screening, and contact tracing, the true impact of COVID-19 is unknown. Roughly 34% of American Indian/Alaska Native (AI/AN) adults aged 18-64 years are at risk of severe COVID-19 due to comorbidities, more than any other racial/ethnic group in the US. Five counties in CN are in the top 20% of US counties for the prevalence of adults at risk of severe COVID-19 due to underlying\nmedical conditions; this vulnerability is compounded by high poverty rates and geographic barriers. People living in rural areas of CN may have to travel as many as 60 miles round-trip for viral testing. CNHS and closely integrated CN public health program have an exemplary, 20-year record of delivering public health interventions, including a groundbreaking Hepatitis C Virus elimination program with the University of Oklahoma Health Sciences Center, and ongoing projects with >40 rural K-12 schools. Drawing on these existing strengths and infrastructure, Cherokee PROTECT addressed the immediate needs for COVID-19 testing and provided a solid foundation for future vaccination efforts. This project generated community-driven solutions to reduce the impact of COVID-19 in underserved, at-risk populations, with a model that could be adapted and scaled for other tribal health systems. The aims of this project were as follows:\nAim 1. Build Infrastructure and Increase FDA-EUA COVID-19 Viral and Antibody Testing for Clinical Care in Cherokee Nation Health System (CNHS).\nAim 2. Enable Community-Based COVID-19 Testing, Contact Tracing, and Education with Cherokee Nation Public Health\nAim 3. Identify/address barriers to testing and contact tracing to inform educational campaign\nAim 4. Evaluation and Data Management