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RADx-UP Community Collaboration Grant brings COVID-19 testing, vaccination to Mississippi Delta communities

Posted on by wendy.farmer@duke.edu

Associated RADx-UP Project: CDCC Community Collaboration Grant
Principal investigator: Erin Shirley Orey
Population focus: Communities in the Mississippi Delta 
Community partner: Drs. Aaron & Ollye Shirley Foundation

The Mississippi Delta, an agricultural region along the Mississippi River, is an underserved area in rural Mississippi with very few physical health centers. Many residents also don’t have health insurance or are underinsured, making it extremely difficult to access health care.

During the COVID-19 pandemic, those with symptoms struggled to access care. Access to testing was just as difficult, with the closest testing centers often located 20 miles away and no public transportation options.

“At that time, the Mississippi State Health Department was providing COVID-19 testing, or you could go to a community health center, but we were right in the dead of nowhere,” explained Erin Shirley Orey of the Drs. Aaron & Ollye Shirley Foundation, a nonprofit organization with a mission to promote the health and well-being of underserved communities in Mississippi.

COVID-19 test scheduling was available exclusively online in the early days of the pandemic. For the many residents without internet access and older adults, it was challenging to schedule tests, even if the individual could get to the facility.

These factors and other made it nearly impossible for residents to keep themselves and their families protected from the virus.

Enter the Shirley Foundation. Organization leaders applied for and received a RADx-UP Community Collaboration Grant, which enabled them to bring walk-in COVID-19 testing directly to Mississippi Delta communities, specifically Holmes and Humphreys counties.

The RADx-UP CDCC Community Collaboration Grant Program awarded up to $50,000 for direct costs per project to support community partners working to advance capacity, training, support, and community experience with COVID-19 testing initiatives. The Shirley Foundation was one of 69 community-serving organizations nationwide to receive a RADx-UP grant.

The Foundation partnered with Mississippi’s Mallory Community Health Center, which had an existing mobile unit that brings various wellness services and screenings to rural areas after setting up in convenient locations.

“So we would go into those communities and provide COVID-19 testing,” Orey explained.

The effort expanded to provide vaccination when vaccines became available. Orey said this grant made a huge difference for the Delta communities.

“When they see the mobile unit in the community when they drive by people just stop,” she said. “That was their doctor’s visit. If I live in a community where a clinic does not exist, this is a life-changing experience for so many people because they could come and see a nurse practitioner right there in their community.”

The Foundation’s effort resulted in 23 events in this rural area between October 2021 and July 2022. They administered 152 COVID-19 tests, 175 vaccines, and 110 booster shots. Sixty-one people received both testing and vaccination services in the same visit.

She notes that the Community Collaboration Grant provided the capacity for COVID-19 testing in an area where it was critically needed and not previously available.

“Especially because a county health department is not going to be at every street corner. This type of grant gives community organizations access to serve smaller communities that just are not close or not near a county health department.”

Reflecting on the success and what others can learn, Orey highlighted the value of partnering with local community organizations, including faith-based organizations, local governments, and other community partners. She said these relationships will be valuable in future health emergencies.

“The main lesson I took from the whole experience is that when there is an emergency, and everybody is trying to reach the same goal, it’s easy,” she said. “People come together. Organizations will come together to make sure that their communities have what they need to be healthy. RADx-UP was one of those key partners, and the grant made it all possible.”

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RADx-UP project studies intersection of violence & COVID in Chicago

Posted on by Kayla Korzekwinski

11.15.2022

The RADx-UP consortium gathers each month to hear program updates and presentations about community-engaged research activities across the United States, its territories, and Tribal Nations. This article recaps a recent project presentation by Katherine Quinn of the Medical College of Wisconsin.

In the spring of 2020, Black residents of Chicago faced two compounding crises. First, they were experiencing a disproportionate share of COVID-19 mortality – 75% of deaths were among Black and Latino residents, and they were clustered in the majority-Black south and west sides of the city.

Heatmap that shows African American Population by Census Tract in Chicago, IL (2017).

And the disproportionate death toll wasn’t ending with COVID-19; neighborhood and police violence were impacting Black communities, as well. In June, 80% of firearm-related death victims in Chicago were Black – and exposure to violence can negatively impact the mental health of the next generation.

It was the culmination of these events that prompted VOICES: The Violence and COVID Equity Study. Katherine Quinn and her team at the Medical College of Wisconsin sought to investigate what they called the COVID-19 Racism and Violence Syndemic.

Syndemics, Quinn explained, occur when two or more epidemics interact and mutually reinforce the adverse health outcomes of the other. Though syndemics is a term more commonly used in a biomedical context, Quinn’s team recognized racism and violence as epidemics, contributing to the disparities in COVID-19 outcomes and vaccination rates. They sought to understand how racism, violence, mental health, and other social and structural factors may influence COVID-19 vaccination disparities in Chicago.

STUDY FINDINGS

The data from both the surveys and the interviews are still being assessed, but preliminary interview analyses identified four primary themes:

  1. There is a prominent intersection of racism and violence in Chicago
  2. Longstanding structural inequities in the city were laid bare by COVID-19
  3. The pervasiveness of racism and violence contributes to poor mental health
  4. COVID-19, racism, and violence interact to create syndemic conditions

Quinn highlighted several quotes from participants that spoke to structural inequity in Chicago, a lack of trust in the government and healthcare, and the distress caused by exposure to violence.

“I think these…excerpts really start to shed light on how much the violence and mistreatment reverberate through communities contributing to this toxic chronic stress, anxiety, and depression,” Quinn said.

The preliminary survey results indicated something similar. Neighborhood violence and interpersonal racism were both associated with an increase in medical mistrust – especially in regard to COVID-19 information – and an increase in depressive symptoms. Police violence was associated with an increase in depressive symptoms, as well.

CONCLUSIONS AND LESSONS LEARNED

These preliminary analyses suggest that racism and neighborhood violence indirectly influence COVID-19 vaccination. And they do so through proxies, such as medical mistrust and distrust of COVID-related information.

“We cannot think about and talk about and address the disparities in COVID without acknowledging and addressing some of the larger barriers and larger structural challenges that many communities – not just Chicago – are experiencing,” Quinn said.

Going forward, public health efforts must consider related social and structural inequities, Quinn said. And ongoing efforts to increase COVID-19 vaccination must include community leaders in order to reduce medical mistrust.

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Connecting People Experiencing Homelessness and Housing Instability to Rapid COVID-19 Testing

Posted on by Kayla Korzekwinski

Associated RADx-UP Project: Rapid Research Pilot Grant: Implementation and Evaluation of Point of Care COVID Diagnostics for Individuals Experiencing Homelessness in Revere
Principal investigator: Priya Sarin Gupta, MD, MPH, Medical Director of Massachusetts General Hospital Mobile Community Program
Population focus: People experiencing homelessness and housing instability
Research institution: Kraft Center for Community Health at Massachusetts General Hospital

A clinic on wheels and 15-minute COVID-19 test results

This RADx-UP CDCC Rapid Pilot (RP2) project is an effort to evaluate a COVID-19 testing strategy for people in Revere, Massachusetts who are at the most risk of getting and spreading COVID-19 due to the circumstances of their homelessness or housing instability.

By converting a van into a mobile testing and vaccination clinic, the medical team along with their community partners created a trusted space where positive cases are detected in 15 minutes and individuals can be connected to other health care and community services right away to support quarantine and recovery.

“The idea is to provide that same care that we're able to provide in our brick-and-mortar facility but, kind of, turn the hospital inside out and meet people out in the community,” said Priya Sarin Gupta “It's more like ‘The patient will see us now’, instead of ‘The doctor will see you now,’ as has been the typical paradigm in medicine.”

This project’s mobile clinic uses rapid COVID-19 tests that give results in 15 minutes, a turnaround time that is responsive to the realities of the population being served. For example, people experiencing homelessness or housing insecurity may not have access to a phone or the internet to receive their test results, and they may live in close-proximity environments such as multi-generational households or shelters. Quick COVID-19 test results allow people to take immediate action in the case of a positive result as opposed to waiting hours or days to find out. People who do test positive are then connected to resources, food boxes, and assistance in finding somewhere to stay during quarantine.

“What we hypothesize, and are trying to test with this work, is that by being able to give the individual a reliable COVID result within 15 minutes of the encounter – when they're still present in our care setting – we may be able to better address some of those other things that need to be addressed,” said Gupta.

RADx-UP CDCC Rapid Research Pilot Program

Like the larger community-engaged RADx-UP clinical research sites, the RP2 short-term projects propose to implement strategies or interventions that have the potential to rapidly increase the reach, access, acceptance, and uptake of FDA-authorized or emergency use authorization (EAU) approved diagnostics among communities who have been hardest hit by the pandemic.

In addition to people experiencing housing insecurity, these populations include African Americans and American Indians/Alaska Natives; those in nursing homes, jails, rural areas, or underserved urban areas; and pregnant women.

RP2 researchers have collaborations with the communities they serve — tribal health centers, houses of worship, homeless shelters, and prison systems — ensuring the studies and findings are responsive to the culture and needs of each community.

“Facilitating access to tests will both uncover the barriers to testing while also keeping disproportionally affected communities safer while we get through the continuously evolving COVID-19 pandemic together,” said RADx-UP CDCC Research Scientist and RP2 Program Manager Tim Veldman.

The one-year project scope allows for a quick implementation and evaluation of testing technologies in real-time. This award of up to $200,000 is meant to be manageable in a one-year time frame to be most responsive to the urgent and current needs of these communities. The RP2 program is one of two grant opportunities offered by the CDCC. The other is a Community Collaboration Grant that awards up to $50,000 for COVID-19 testing education and outreach projects that do not have a clinical trial requirement.

Advancements in addressing health disparities through rapid clinical studies

The overarching goal of the RADx-UP initiative is to understand the factors associated with disparities in COVID-19 morbidity and mortality and to lay the foundation to reduce disparities for those underserved and vulnerable populations who are disproportionately affected by, have the highest infection rates of, and/or are most at risk for complications or poor outcomes from the COVID-19 pandemic.

In Revere, Dr. Gupta and the Kraft Center have found something that works: taking rapid tests to where the unhoused and housing-vulnerable communities congregate in their town.

“The long-term plan is to use this pilot data and to develop it into something that stays as a program, because what we are beginning to realize is that COVID is going to become endemic,” said Gupta. “We're going to use the results of this work and other work that we've been doing for the last year to help develop a sustainable program, to make sure that really no one gets left behind when it comes to COVID testing, vaccinations and treatment.”

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Tribal Nations and the COVID-19 Pandemic: Spero Manson

Posted on by Mary Lindsley

Associated RADx-UP project: The RADx-UP American Indian Alaska Native Working Group
Speaker: Spero M. Manson
Distinguished Professor, Public Health and Psychiatry
Director, Centers for American Indian and Alaskan Native Health
University of Colorado, Anschutz Medical Campus

Quotes from the spotlight

Native American communities and consequences of pandemics throughout history

"The experience that Native people have of this current pandemic really has to be understood in the context of past experiences of a similar nature. I mentioned before in a recent article in Health Equity the nature and course of such experiences with smallpox, typhoid, measles, tuberculosis, and the enormous consequences those epidemics had on the daily lives of Native people.

"One of the key aspects of life in Native communities is this notion that our sense of self and personhood are really a matter of the collective, reinforced by one's family, played out among others, and ultimately is embedded within this broader landscape of social and cultural factors. Pandemics of this nature threaten to unravel those circumstances. And as a consequence, cast many of us adrift, whether we experience the consequences of the pandemic directly or vicariously through the loss of our loved ones in community."

Tribal Nations are separate governments and data collection and sharing requires government to government agreements

"American Indian and Alaskan Native communities, particularly those within the jurisdictional boundaries of their federally recognized reservations, are domestic dependent sovereignties—actually governments—that the federal government has recognized as needing a special relationship. The relationship proceeds under the rubric of government-to-government relationships. Matters of authority with respect to what kinds of questions can be asked, the sharing of data, the nature of partnerships, are all colored by this government-to-government relationship."

Key Native American leaders and other stakeholders formed a working group to address concerns in collaboration with the CDCC and NIH

"The working group is led by Dr. Sohail Khan from the Cherokee Nation of Oklahoma and a colleague from the Northern Plains, Tinka Duran. They are the ones responsible for coordinating these conversations, bringing together these key stakeholders and formulating our recommendations in turn to the CDCC and NIH.

"This working group provided many concrete examples of the ways in which particular common data elements simply made no sense in the lives of our people living in these communities. In fact, a number of these common data elements could raise warning signs among our communities that potentially might be stigmatizing and thus not supportable."

The CDCC and NIH had not fully considered the perspectives of American Indian and Alaska Native populations in their development of data collection instruments and other materials

"There are matters of negotiating the nature of the data to be shared, the uses to which it will be put, the individuals or organizations that will have access to it, the manner in which it will be interpreted and presented in the subsequent products of the initiative. The CDCC and NIH, to their credit, were responsive to these particular concerns and, in joint cooperation with the working group and the grantees who comprise it, have worked out a variety of data use agreements and understandings about all of these circumstances surrounding the data."

Bidirectional communication between the National Institutes of Health (NIH) and Tribal Nations is valuable

"I think one of the important outcomes of this initiative is that the conversations have become bidirectional. As a consequence of the working group's contribution to these conversations, NIH has taken the conversations seriously and has pushed the envelope bureaucratically and organizationally to understand as well as accommodate our needs. There is great value to having access and being privy to the perspectives, the values, the agendas that drive other organizations, other communities, other individuals in this endeavor."

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ReSET (Restarting Safe Education and Testing for Children with Medical Complexity)

Posted on by Kayla Korzekwinski

Project name:  ReSET (Restarting Safe Education and Testing for Children with Medical Complexity)
Speaker: Dr. Ryan Coller, Chief of Hospital Medicine Research Director, Pediatric Complex Care Program, Kok-Peng Yu and Anna Lee Shen Assistant Professor of Pediatrics
Population focus:  Children with medical complexity
Research institution: University of Wisconsin

NIH project description

From the interview with Dr. Ryan Coller

“Children with medical complexity have severe chronic conditions, a high need for outside resources due to functional limitations, and substantial family service needs. Most children in this population have many sub-specialists, take many medicines, and spend quite a bit of time in the hospital.

When COVID made it impossible for the population to go to school, it meant that receiving critical instruction and therapies delivered in school became almost impossible. The functional impairments that many of these children have make it almost impossible to interact with educators through virtual technologies. They’ve had significant interruptions in their therapies and education.

The big picture for our project is to promote safe return to school for these children. We’re exploring the feasibility of different testing strategies for children with medical complexity, including in-home and school-based testing, and the extent to which testing helps families feel more comfortable sending their child to school and helps children return to school quickly if they do develop symptoms.

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In addition, knowing the child's COVID status more regularly and reliably can help schools feel comfortable and build in supports for the child and for the family. Every school is essentially reinventing the wheel and trying to figure out how to do this safely for their communities and for their children and families.

We’re also doing a series of surveys of these children’s families at the end of the 2021 school year and the beginning and end of the 2022 school year. This will help us understand what’s influencing parents' decisions about sending their child to school.

And, we’re engaging stakeholders around Wisconsin including families, advocates, clinicians, educators, administrators, and school nurses from around the state to crowdsource ideas of what is needed for children with medical complexity to be at school safely. We aim to apply that information to build tools to support schools in the next school year.

The types of information people are sharing with us and the types of learning that we're generating from our work is going to be relevant to other states around the country. We are excited to think about how our work could be translated, either replicated and adapted in other settings or just adopted and implemented where it is relevant.”

DR. RYAN COLLER:

“Every school is essentially reinventing the wheel and trying to figure out how to do this safely for their communities and for their children and families.”

COV-IDD: Testing for COVID-19 in High Risk Children with Intellectual and Developmental Disabilities

Posted on by Kayla Korzekwinski

Project name:  COV-IDD
Speaker: John Foxe, Ph.D., Chair of Department of Neuroscience, Director of Del Monte Institute for Neuroscience
Population focus:  Children with intellectual and developmental disabilities
Research institution: University of Rochester

NIH project description

From the Interview with John Foxe, Ph.D.

“A year of lost instruction to a child who is developmentally behind is a disaster. People with intellectual and developmental disabilities don't just go to school for learning; they also receive care from providers like occupational therapists, physical therapists, speech pathologists, and pulmonary specialists at school. When a child with severe intellectual and developmental disability stays home, that also takes the parents out of the workforce. So, school is also a release for parents so they can go about their lives.

Our project consists of biological testing, standard testing, serological testing, understanding antibodies, and a mobile testing unit. Can we devise systems to get out into the community flexibly to make life easier for everybody? There is also a mathematical modeling component to determine how little testing we can do to be effective in cutting off this disease. And a strong public information campaign is a very important aspect of our project.

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I've been in this business for 30 years, and have learned more in the past year in science than I have in the previous 29. As a neurobiologist I never thought I'd be talking about vaccination campaigns and testing campaigns for a virus and a pandemic, but here I am, taking my skillset as a scientist, and bringing those skills to bear on this really important problem.

Typically I think about how to ameliorate the symptoms of autism. To generate new therapies to train them to navigate the world a little bit more successfully, to be the best that they can be. I never thought I'd be worrying about whether they were going to catch a deadly disease, that's all new to me. But these are precious children and as a society, it's how we treat our most vulnerable is the measure of us as humans. And that's why I love working with this population.”

JOHN FOXE, PH.D.:

“These are precious children and as a society, it's how we treat our most vulnerable is the measure of us as humans. And that's why I love working with this population.”

Assessing Testing Strategies for Safe Return to K-12 Schools in an Underserved Population

Posted on by Heather Wilson

Project name:   Assessing Testing Strategies for Safe Return to K-12 Schools in an Underserved Population (Safe Return to Schools), North County, St. Louis, MO
Speaker: Jason Newland, MD, Pediatric Infectious Diseases Physician
Population focus: Racial and ethnic minorities
Research institution: Washington University in St. Louis
NIH project description

From the Interview with Jason Newland, MD

“In St. Louis, there’s a street known as Delmar that runs east/west. If you go north of or east on Delmar, you’re in an area that has suffered greatly from systemic racism. This population is predominantly African-American and has been disproportionately impacted by COVID-19 with greater death and morbidity, and more impact from economic loss than other areas.

There is still a lot to learn from the school districts [in this area], and that's what's so exciting about the project we’ve embarked on. We know in-school transmission is rare based on the work our school districts have done to make it safe. But our school community actually is not just the students and staff that come to school; it's also the people that live in the homes that support the people who go to school. We really are opening this up to make sure that our household members are also involved.

There are so many things to learn [from our project]. Number one, trust the strategies of prevention that have been talked about from the beginning of the pandemic: mass distance, washing your hands, and keeping people out that are sick. Number two, testing has a place in school. What that place is, is still yet to be determined. Most importantly, it just needs to be available.

And the most important learning: let's not create a narrative that's common because it's simple, such as the narrative that our African-American community isn't going back to school because they're scared of COVID and it's ripped through them more. That's what some people assume it to be, but it goes deeper. And we haven't been in the communities to ask them what the right narrative is.

The testing is important, but understanding the narrative of our community is way, way more important, because that's going to have a lasting impact on these communities and will help address the systemic racism to make healthcare better, make school better, and make our communities better.”

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Community Driven Approach to Mitigate COVID 19 Disparities in Hawaii’s Vulnerable Populations

Posted on by Heather Wilson

 

Population focus: Native Hawaiian and Pacific Islanders
Research institution: University of Hawaii at Manoa
NIH project description

The Pacific Alliance Against COVID-19 is working with local Department of Health to expand their pilot model to other school districts in the state. In addition to testing strategy, they have created several culturally specific learning modules for educators and students around COVID-19 protection and prevention, COVID-19 variants and vaccines, the history of infectious diseases in Hawaii, and Genealogy and 'Ohana bubbles. 

This past spring, the RADx-UP project “Community Driven Approach to Mitigate COVID 19 Disparities in Hawaii's Vulnerable Populations” conducted longitudinal testing in public schools in Hawaii in preparation for re-openings in the fall. Learn more in this video (linked and embedded to the right) about how the Pacific Alliance Against COVID-19, a partnership that includes the University of Hawaii and AHARO network of health centers, worked with the Kamaile Academy to keep teachers, staff and students healthy.

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Supporting COVID-19 Prevention and Testing for Marginalized and Minoritized Youth and Young Adults

Posted on by Heather Wilson

Population focus: marginalized and minoritized youth and young adults in Chicago
Research institution: Northwestern University at Chicago
NIH project description 

Early in the pandemic, this RADx-UP project team noticed that almost none of the public messaging about COVID-19 was directed toward youth and young adults. This was concerning because while relatively few youth and young adults die from COVID-19, the pandemic is still having a major impact on their lives. They were especially concerned about young people who also are members of the communities experiencing the social injustices that have created such profound COVID-19 disparities – especially young people of color and/or Latinx background, LGBTQ youth and young adults, and those experiencing homelessness.

Investigators from Northwestern University and Columbia University have partnered with two community organizations (The Broadway Youth Center in Chicago, which serves youth experiencing homelessness, and particularly young people of color; and YouthLink, a program that works with LGBTQ youth-serving organizations), Bowman Performance Consulting, a research organization that advances indigenous knowledge in areas including academic research, and a consultant specializing in Latinx youth.

Together, this diverse team has created a project focused on understanding how LGBTQ and homeless youth and young adults of color are experiencing messaging around COVID-19 and how they’re responding to the pandemic. The goal is to create clear and direct COVID-19 messaging that is relevant to their experiences and motivates them to take the right steps to protect themselves, their families, and their communities.

Early Insights

  • The team’s strong existing relationships with community partners meant they already had established trust, which greatly helped the flow of the project and enabled the team to overcome any issues much more easily.
  • It has been essential to find the right balance between moving expeditiously, given the urgent nature of this topic, and responding to community member feedback.
  • There have been a number of stops and starts due to the need to address a number of competing needs. For example, ensuring data validity while trying to reduce burden on participants has required creative problem solving.
  • A common challenge of community-engaged research is that academic institutions are often not prepared to administratively adapt to the needs of smaller community partners. This has created some administrative and financial hurdles to overcome.

 

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CO-CREATE Increasing COVID-19 Testing for Pregnant Women and Children

Posted on by Heather Wilson

Population focus: Pregnant women and children in San Ysidro, CA
Research institution: University of California, San Diego
Partners: San Ysidro Health; The Global Action Research Center
Website

Pregnant people who contract COVID-19 have an increased risk of severe illness, ICU admission, and death. CO-CREATE is working to increase testing in this at-risk population with a two-phase project. The first phase involves conducting surveys and interviewing patients, medical providers, and community members to understand the challenges and supports involved in getting tested for COVID-19 in San Ysidro.

The second phase, which launched in February 2021, offers testing to all patients at the San Ysidro Maternal and Child Health Center, the supporters and parents/caregivers accompanying them to their appointments, and their contacts in the San Ysidro community. In total, the project will provide more than 90,000 COVID-19 tests over the span of two years.

The second phase, which launched in February 2021, offers testing to all patients at the San Ysidro Maternal and Child Health Center, the supporters and parents/caregivers accompanying them to their appointments, and their contacts in the San Ysidro community. In total, the project will provide more than 90,000 COVID-19 tests over the span of two years.

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Early Insights
A number of factors make COVID-19 testing and prevention more difficult in San Ysidro, including socioeconomic factors that increase the population’s exposure to COVID-19; conflicting and confusing guidance from authorities; inconsistent adherence to and enforcement of the rules; the need for in-person human connection; and housing disparities that have worsened in the pandemic.

The project team has also identified important factors to overcome testing disparities in San Ysidro. These include making testing more inclusive, community-centered, and accessible; ensuring programming is culturally and linguistically competent, and that staff is bilingual and have access to accurate materials and information; and making resources and services available to vulnerable populations, and especially families.