Community Driven Approach to Mitigate COVID-19 Disparities in Hawaii's Vulnerable Populations

The long-term goal of this project was to eliminate COVID-19 disparities among Hawaii's racial/ethnically diverse yet vulnerable populations including Native Hawaiian and other Pacific Islanders (NHPI) living in rural and underserved communities. This relied on integrating innovative SARS-CoV-2 testing capacity with novel community-specific messaging and education. Compounded by long-standing health disparities and socioeconomic challenges, NHPIs suffer from increased infection and mortality rates attributed to COVID-19. To date, NHPIs rank among the highest disproportionately burdened by SARS-CoV-2 in the U.S. With the nation's highest Rt, a basic reproductive metric indicating the degree of viral spread, Hawaii's disaggregated NHPI data reveal further disparities. Preliminary testing data collected by the Waianae Coast Comprehensive Health Center (WCCHC), Hawaii's largest federally funded community health center, indicated a significant deficiency in testing uptake, especially among Pacific Islanders. Under-representative coverage of testing among youth (ages 5-19 years old) in NHPI communities was observed, despite their higher than average infection rate. Other factors, including slow testing turnaround time and untested asymptomatic cases, complicated efforts to contain further community spread. Given the looming public health concerns around the re-opening of businesses and schools, these gaps highlighted the critical need for innovative approaches to effecting behavioral change coupled with novel testing strategies to enhance access to all community members, including school-aged children/youth. Fortunately, existing partnerships in Hawaii's culturally diverse populations offered a unique opportunity to augment the COVID-19 response with community knowledge and resilience. It was hypothesized that community-contextualized messaging disseminated by novel healthcare-school partnerships, coupled with a robust community and patient-centered testing strategy, would increase reach, access, uptake, and impact for COVID-19 testing in vulnerable populations. To test this hypothesis, the multidisciplinary team: (1) evaluated SARS-CoV-2 testing data, identified gaps and barriers in testing, and augmented community testing capacity to increase uptake, and (2) optimized and implemented community-informed COVID-19 messaging and education with a novel community healthcare-school network partnership in the NHPI population across Hawaii. Building on the parent Ola HAWAII grant, this project leveraged existing Community Engagement, Biostatistics, and Administrative Cores with the NHIP partnerships to augment the RADx-UP Coordinating and Data Collection Center for common evaluation metrics on COVID-19 testing-related outcomes and implementation. This project provided the foundation for an engaged community network primed for disseminating anticipated vaccines in Hawaii's highest risk populations. Given the urgency to both improve public health safety and re-open schools, results from this project offered insights into an integrated model or toolkit from which health clinics and schools in underserved and vulnerable communities across the country might actively participate in abating the pandemic.