Community-Engaged Approaches to Testing in Community and Healthcare Settings for Underserved Populations (CATCH-UP)

The pandemic caused by the novel coronavirus SARS-CoV-2 has resulted in substantial global morbidity and mortality, including in Oklahoma, and caused unprecedented interruptions in nearly all aspects of life. COVID-19 has demonstrated considerable disparities based on age and certain chronic illnesses as well as other social determinants of health. The population of the state of Oklahoma is at particular risk to SARS-CoV-2 due to its large rural population, strained healthcare system, and poor overall health. Rural populations in general are medically underserved, older, and experience significant health disparities that overlap with those comorbid conditions that can result in severe cases or even death from the infection. The Oklahoma Shared Clinical and Translational Resources (OSCTR) and its long-standing community-engaged research programs and partnerships are perfectly positioned to contribute to the knowledge base necessary to improve the effectiveness of interventions to increase testing in underserved and vulnerable populations. An approach was designed that not only allows for the collection of essential information about community, provider, and patient-relevant impediments to SARS-CoV-2 diagnostic testing, but also met the critical need to increase testing in the state of Oklahoma as rapidly as possible. The Community-engaged Approaches to Testing in Community and Healthcare settings for Underserved Populations (CATCH-UP) program involved both practice-based and community-based approaches to maximize the reach of the RADx-UP consortium, broaden the potential perspectives that could be captured, and compare the effectiveness of strategies. The interventions were pragmatic to allow CATCH-UP to respond to changing attitudes, barriers, and environments as the pandemic progressed as well as expected technology developments to produce more effective viral testing that can provide rapid results to patients. The practice-based intervention utilized existing research infrastructure to assist 50 small primary care practices to implement guidelines-based testing and patient education about COVID-19 and risk mitigation strategies. This community-based approach was designed to rapidly respond to community testing needs by deploying mobile testing sites that provided operational support to increase the efficiency and the existing capacity for state-wide testing by Oklahoma's public health authorities. It was estimated that the CATCH-UP program would result in at least 105,000 SARS-CoV-2 tests performed during the first year of implementation. A comprehensive, ongoing evaluation was performed to analyze patient and provider attitudes, barriers and facilitators of viral testing, identified health disparities caused by COVID-19, effectiveness of the intervention in both settings, and to allow robust collaboration with other RADx-UP consortium sites.