Developing Novel Strategies to Increase COVID-19 Testing Among Underserved and Vulnerable Populations in West Virginia through Community and State Partnerships

West Virginia (WV) is rated by Becker’s Hospital Review as the state with the sixth most vulnerable population to the novel coronavirus (SARS CoV-2) while a second group at Wallethub, using three key domains (medical, housing, financial), rates WV as the most vulnerable state to SARS CoV-2 impact. Central to the state’s extreme vulnerability is the high prevalence of obesity, cardiovascular disease including hypertension, chronic lung disease due to smoking and environmental exposure (e.g., mining), diabetes mellitus, and cancer. Additionally, WV is among the three states having the highest proportion of persons > age 65 years (20%). Through school and university closures in March 2020, along with shutdown of non-essential businesses, WV had relatively few COVID-19 cases and deaths until July 2020 when transmissibility (Rt) skyrocketed. Testing remains problematic in WV for multiple reasons, including inadequate testing supplies, accessibility to testing sites (given the rurality of the state and lack of widespread public transportation), shortages of personal protective equipment for staff, and lack of insurance coverage for surveillance testing and for uninsured persons. The West Virginia Clinical and Translational Science Institute (WVCTSI) is submitting this application in partnership with multiple organizations with which they have existing collaborative relationships, including: 1) the WV Practice Based Research Network (PBRN), a 107 site primary care network spanning the state, 2) the WV Department of Health and Human Resources, 3) the WV National Guard, 4) West Virginia University (WVU) Health Sciences Center and College of Engineering, and 5) the Communities of Color. Critically important is the generous match of $1.5 MM that the state of WV is offering to this initiative should this supplement receive funding. Vulnerable populations addressed in the application include individuals in rural communities and African American populations as well as those with comorbidities known to increase risk of severe COVID-19. Given the high prevalence of substance use disorder (SUD) in WV, a cross-cutting theme is ensuring persons with SUD are included in all proposed strategies to increase SARS CoV-2 testing. We will address COVID-19 testing disparities through achievement of the following specific aims, all of which use nucleic acid polymerase chain reaction testing on nasal or nasopharyngeal swabs: 1) Enhance COVID-19 testing among rural primary care offices located across WV, 2) Intensify COVID-19 testing through mobile vans in areas forecasted to experience a near-term increase in COVID-19 incidence, and 3) Increase COVID-19 testing in Black or African American communities through a dedicated mobile van and home testing. Evaluation of implemented strategies includes assessing numbers of tests performed, uptake of home testing, satisfaction surveys, and structured interviews among Black or African Americans enrolled in the home testing study.

西弗吉尼亚州（West Virginia，简称WV）被《贝克尔医院评论》（Becker’s Hospital Review）评为新型冠状病毒（SARS-CoV-2）易感人群排名第六的州；而WalletHub旗下的另一研究团队则以医疗、住房、金融三大核心维度为评估标准，将WV评为受SARS-CoV-2影响风险最高的州。该州极易受疫情冲击的核心原因在于，肥胖、包含高血压在内的心血管疾病、吸烟及环境暴露（如采矿作业）所致的慢性肺部疾病、糖尿病与癌症的患病率居高不下。此外，WV是全美65岁以上人口占比最高的三个州之一，该群体占总人口的20%。2020年3月，WV通过关闭各级学校与高校、关停非必需商业场所的防疫措施，在2020年7月之前，该州新冠确诊病例与死亡病例数均处于较低水平；但同年7月，病毒传播能力（Rt）骤升，疫情快速扩散。WV的新冠检测工作仍存在多重阻碍：检测物资供应不足、受该州乡村地域特征及公共交通覆盖率低的限制导致检测点可及性较差、一线医护人员个人防护装备（personal protective equipment, PPE）短缺，以及监测性检测费用与无医保人群的检测费用均未被保险覆盖。西弗吉尼亚州临床与转化科学研究所（WVCTSI）正与其长期合作的多家机构联合提交本申请，合作方包括：1）西弗吉尼亚州基于实践的研究网络（PBRN）——覆盖全州的107个基层医疗站点组成的协作网络；2）西弗吉尼亚州卫生与公众服务部；3）西弗吉尼亚州国民警卫队；4）西弗吉尼亚大学（WVU）健康科学中心与工程学院；5）少数族裔社区。尤为关键的是，若本补充申请获得资助，西弗吉尼亚州将为该项目提供150万美元的配套资金，为项目实施提供坚实支撑。本申请针对的易感人群包括乡村社区居民、非裔美国人群体，以及已知会增加新冠重症风险的共病患者。鉴于WV州物质使用障碍（SUD）患病率较高，本项目设置了一项贯穿所有策略的核心要求：确保所有物质使用障碍患者均被纳入新冠检测扩增方案。本项目将通过以下三项具体目标解决新冠检测的公平性差异问题，所有检测均采用鼻拭子或鼻咽拭子进行核酸聚合酶链式反应（PCR）检测：1）提升WV州基层乡村诊所的新冠检测覆盖率；2）在预计新冠发病率近期将上升的区域，通过移动检测车强化新冠检测工作；3）通过专属移动检测车与居家检测服务，提升非裔/黑人社区的新冠检测率。对已实施策略的评估将涵盖：已完成的检测样本量、居家检测的参与率、满意度调查，以及对参与居家检测研究的非裔/黑人群体开展的结构化访谈。