C2SPARC: Implementing Mobile, POC COVID-19 Testing in Partnership with a Community-Based Organization to Reach Women Who Use Drugs

Through our RADx-UP Phase I “CARE” study, we are examining correlates of point-of-care COVID-19 testing (POCT) uptake at baseline and reuptake at a 3-month follow-up visit among WWUD (N=250) in Baltimore, MD. In this Phase II, “C2SPARC” study, we will examine POCT uptake in both research and service delivery contexts. Specifically, we propose adding a 6-month visit (“C2SPARC visit”) among the CARE cohort in order to examine trends in POCT uptake over time. Secondly, in partnership with the SPARC Center, a leading harm reduction organization that serves WWUD, we propose designing and implementing POCT on their nighttime mobile outreach van that provides harm reduction supplies (e.g., condoms, naloxone, syringes), basic necessities (e.g., food, clothing), and trauma informed micro-counseling. C2SPARC leverages long-term community partnerships (see letters of support), an existing Community Advisory Board (CAB), and a well-established research infrastructure. The study will employ Andersen’s Behavioral Model10 (Aim 1), PRISM (Practical, Robust, Implementation, and Sustainability Model)11 (Aim 2), and the Theoretical Framework of Acceptability (TFA)12 (Aim 3) to meet the following aims.
1. To examine predisposing (e.g., social - homelessness, food insecurity; individual - drug use, race/ ethnicity, health beliefs) and enabling (prior COVID-19 testing, vaccine uptake) factors that predict uptake of POCT over a six-month period in WWUD (N=250) in Baltimore, Maryland.
2. To collaborate with the SPARC Center to develop and implement POCT on their mobile outreach van that primarily serves WWUD in Baltimore City, Maryland.
3. To examine the feasibility (e.g., testing uptake) and acceptability (e.g., participant burden, testing self-efficacy) of mobile POCT among WWUD (N=250) who are clients of SPARC outreach.
Through Aim 1, we will examine a range of predisposing (social and individual) and enabling factors that predict POCT uptake over a six-month period. By leveraging Phase I’s existing cohort and data collection, the C2SPARC visit doubles the follow-up length, allowing for longitudinal data analysis. Predictors of POCT uptake are shaped by Andersen’s Behavioral framework10 and informed by our extensive prior research with the study population.1,13-15 The C2SPARC visit leverages the existing Phase I CARE research infrastructure, which is built on 15 years of community-engaged field research among WWUD and female sex workers (FSW) who use drugs. This additional data collection wave will deepen our understanding of the drivers of COVID-19 testing uptake among this highly marginalized population in the context of a rapidly evolving testing and vaccine landscape. Through Aim 2, we will partner with the SPARC Center to develop, pilot, and implement a POCT service two nights per week on their outreach van (see “Preliminary Studies”). This implementation process will be informed by Aim 1 findings and by formative qualitative data collection including key informant interviews with outreach staff (N=5) and systematic observations (N=6) of the SPARC outreach van, guided by the PRISM framework.11 Through Aim 3, we will assess the program feasibility (i.e., testing uptake) of POCT on SPARC outreach through analyzing SPARC outreach administrative data. We will employ the TFA framework to measure acceptability of COVID-19 testing via a brief anonymous survey administered to SPARC clients (N=250) when POCT is offered. C2SPARC is innovative in leveraging the Phase I cohort in examining drivers of POCT uptake longitudinally, which will then inform the implementation of POCT on a highly subscribed mobile outreach van. Further, situating POCT in the context of existing relationships with trusted service providers is urgently needed. The study’s impact and sustainability will further be enhanced by the engagement of a seasoned CAB. C2SPARC is responsive to NOT-OD-21-103 in that it expands the RADx-UP Phase I study to build “enhanced point-of-care infrastructures that can be sustained beyond the current pandemic.” Study results can be quickly disseminated to the target population, service providers, and policy makers through products (i.e., fact sheets, manuscripts) and events (i.e., community forums) to inform community-based testing and eventual vaccination programs targeting WWUD and similarly marginalized populations