Alive Church Network: Increasing COVID-19 Testing in Chicago's African American Testing Deserts

The epidemic of novel coronavirus disease 2019 (COVID-19) has caused an unprecedented public health crisis in the United States. African Americans (AA) have been disproportionately impacted, as systemic inequities have contributed to increased exposure and vulnerability to COVID-19. Evidence suggests that AAs are delaying testing and care for COVID-19, which increases risk of transmission and poor outcomes. In Chicago, segregated AA neighborhoods have experienced some of the highest COVID-19 mortality rates in the city, yet large portions of these neighborhoods remain testing deserts. Providing trusted, accessible, community-based testing in underserved AA communities is critical to ensuring that individuals receive an early diagnosis, thereby reducing the risk of further transmission and improving clinical outcomes. This study leveraged the Alive Church Network (ACN), a long-standing, community-driven coalition of African American pastors and public health researchers that was developed as a sustainable infrastructure to address health inequities in chronic disease in segregated AA neighborhoods in Chicago. The ACN was designed to address lack of access to health care, cultural insensitivity, and lack of trust, which are the root cause of disparities in chronic disease as well as infectious disease, including COVID-19. The project utilized the ACN infrastructure to create a network of church-based testing sites in a segregated and underserved AA neighborhood in Chicago that provided COVID-19 testing and education as well as linkage to healthcare and social resources. Thirteen ACN pastors who served predominantly AA congregations in the West Side of Chicago formed a coalition to promote community-wide COVID-19 testing in local churches. Residents of all ages received COVID-19 education and free SARS-CoV- 2 PCR testing with rapid turn-around of results from an on-site clinical team, as well as connection to local resources to address social needs, including food, housing, and medical care. The specific aims of this study were: (1) Conduct a rapid needs assessment to identify barriers to and facilitators of COVID-19 testing to inform a tailored outreach and intervention strategy to increase COVID-19 testing among high-risk AAs; (2 – Primary Aim) Evaluate the impact of the ACN COVID-19 testing intervention on uptake of testing among residents of target high poverty AA neighborhoods in Chicago; (3) Use the RE-AIM framework to assess the reach, adoption, implementation, maintenance and cost of the ACN COVID-19 testing intervention. The primary analysis used an interrupted time series framework, which is a quasi-experimental approach, to test whether the ACN testing intervention was successful at increasing uptake of testing by at least 20% among residents in the target neighborhoods. Completion of these aims provided crucial evidence about the public health utility of this approach and informed efforts to scale this intervention to increase testing uptake in other vulnerable urban areas in Chicago and nationally.