A Dynamic COVID-19 Community-Engaged Testing Strategy in Alabama (COVID COMET AL)

Background: This study sought to understand the factors associated with COVID-19 morbidity and mortality disparities and to lay the foundation for reducing disparities among underserved and vulnerable populations. These groups had been disproportionately affected, experienced the highest infection rates, and were most at risk for adverse outcomes from the COVID-19 pandemic. The study was conducted in Alabama and focused on assessing modality and venue preferences for COVID-19 testing in rural, incarcerated, and other underserved populations. The overarching objective was to evaluate the implementation of a rapid scale-up SARS-CoV-2 testing strategy.

Materials/Methods: The study identified high- and low-burden counties using case rates and mapped vulnerable communities with Census data, the COVID-19 vulnerability index, healthcare access, risk factors, and measures of mitigation efforts. These analyses guided prioritization of rural counties for testing and used only publicly available aggregate data. The study administered COVID-19 tests across underserved rural populations in partnership with the Alabama Area Health Education Centers, and evaluated the testing initiative’s implementation strategy by surveying researchers, administrators, and testing staff, as well as collected surveys from rural participants.

Outcome/Impact: From October 1, 2020, until February 28, 2022, the study administered over 23,000 PCR tests, which resulted in a 12 percent positivity rate. This included testing with the Visby point-of-care PCR test developed via RADx Tech, which had particular uptake in rural jails across Alabama.