Faithful Response II: COVID-19 Rapid Test-to-Treat with African American Churches

Background: Many multilayered barriers increase risk for COVID-19 among African Americans (AA), including poverty, essential jobs with increased exposures, cultural norms such as risk denial and mistrust of medical systems, chronic health conditions, and limited access to healthcare and resources. These barriers highlight the need for accessible, trusted COVID-19 testing and linkage to antiviral treatment and care (LTC), as well as community resources such as food and rent assistance. AA churches are institutions with extensive influence in AA communities and may be an ideal setting for delivering COVID-19 test-to-treat (TTT) interventions.

Materials/Methods: This study tested a culturally and religiously tailored, church-based COVID-19 TTT with LTC intervention against a non-tailored education condition on rapid testing rates at 6 months with AA adult church members and the communities they served. Secondary outcomes included antiviral and contact tracing intentions and use at 6 months, as well as other types of COVID-19 testing and LTC use. The intervention was delivered using a community-engaged approach in which trained church leaders implemented a culturally appropriate COVID-19 TTT Toolkit that included individual self-help materials, automated and tailored text messages, ministry group educational information, integration into church services with sermons, pastor modeling, testimonials, and bulletins, and church-community LTC services provided by contact tracers serving as community health workers. Intervention churches hosted two COVID-19 TTT events and distributed take-home rapid self-test kits. Mediators and moderators related to testing uptake were assessed, and process evaluations identified implementation facilitators, barriers, and fidelity.

Outcome/Impact: This study was the first to fully test a COVID-19 TTT intervention in AA churches and aimed to increase COVID-19 testing rates, antiviral use, and contact tracing uptake, while identifying barriers and facilitators to implementation. The study provided a theory-based, multilevel, scalable model for equipping AA churches to deliver wide-reaching COVID-19 testing and linkage to treatment with health agency partners.