In collaboration with community partners, this study will identify disparities anddynamics of COVID-19 testing and infections in three Texas regions; and implement amultilevel intervention that increases access to testing and referrals to follow-up careamong vulnerable populations. Using a three-arm group-randomized controlled trial, thisstudy will assess the impact of multi-level interventions influencing motivation andaccess to testing.The outcomes of this study are measured at the population level and no individual datawill be gathered. Analyses of de-identified PHI data from local and regional healthdepartments on COVID testing and infection rates will be used to assess interventionoutcomes.
In the U.S. vulnerable populations experience significant disparities in terms of both
COVID-19 infection and mortality rates, especially in Texas, where Hispanic, African
Americans, and other groups have experienced substantial disparities in both incidence
and mortality. Building on the partnerships and resources of the Center for Clinical and
Translational Science (CCTS), the goal of the proposed project is to identify dynamic
COVID-19 disease hotspots and testing deserts in racially diverse regions of South Texas,
Houston/Harris County, Texas, and Northeast Texas to inform the rapid adaptation and
deployment of multilevel level just-in-time adaptive intervention strategies to reduce
testing disparities among vulnerable populations.
A group-randomized controlled trial (RCT) will be conducted to evaluate the reach,
effectiveness, and implementation of a community-level Just-In-Time-Adaptive-Intervention
(JITAI) to increase COVID-19 testing in identified high-risk priority neighborhoods. To
conduct the RCT, 120 priority census blocks groups will be identified and randomized to
each condition using a community risk index score that balances distribution in the three
study arms with respect to important characteristics including population density,
demographics, and baseline testing rates.
In Intervention Condition 1 - Multi-Level Multi-Component Intervention (MLI), individuals
will receive a multilevel, multi-component intervention comprising of 1) Building testing
access for vulnerable populations, 2) Community Health Worker (CHW)-delivered navigation
to COVID-19 testing and access and reinforcing risk mitigation recommendations; 3) 2-1-1
helpline-referrals and navigation to testing and 4) social marketing and small media
campaign to provide geo-targeted messages promoting testing and COVID-19 risk mitigation
behaviors. In Intervention Condition 2 - Community JITAI individuals will receive the
same MLI intervention components but with an added JITAI approach informed by real-time
data related to testing and other relevant information based on community and stakeholder
experience and tacit knowledge about factors influencing testing determinants. The
Comparison Condition will receive standard exposure to ongoing city and county
communication and access to testing.
Behavioral: Multi-Level Multi-Component Intervention (MLI)
The strategic components of our multi-level, multi-component intervention (MLI) include:
1. Building testing access for vulnerable populations, 2) Community Health Worker
(CHW)-delivered navigation to SARSCoV- 2 testing and access and reinforce risk mitigation
recommendations, 3) 2-1-1 helpline-referrals and navigation to FDA approved SARSCoV- 2
testing (and self sampling once approved) and risk mitigation education, and 4) social
marketing and small media campaign to provide geo-targeted messages promoting testing and
COVID risk mitigation behaviors. We selected these components because of their evidence
base, their current use by partners in response to COVID 19, and confidence that they can
be adapted through a community engaged process as described.
Behavioral: Community Just-In-Time Adaptive Intervention (Community JITAI)
This intervention includes the same MLI components described above, with an added JITAI
approach. Community and stakeholder partners will use real-time data related to testing
and other relevant information generated by the Epidemiologic Surveillance and Analysis
team (ESA) in Aim 1, as well as other information based on their community and
stakeholder experience and tacit knowledge about factors influencing testing
determinants, to adapt intervention activities as needed to optimize access to testing.
Inclusion Criteria:
- residing in identified COVID-19 hotspots and testing deserts within study regions
- aged 18 years or older
Exclusion Criteria:
- aged under 18 years
The University of Texas Health Science Center, Brownsville
Brownsville, Texas, United States
The University of Texas Health Science Center at Houston
Houston, Texas, United States
The University of Texas Health Science Center at Tyler
Tyler, Texas, United States