SUMMARY The COVID-19 pandemic disproportionately impacts members of under-represented minority (URM) communi- ties. Unfortunately, URM and other vulnerable communities remain profoundly under-tested. As such, new ap- proaches are needed to disseminate and accomplish testing that could be generalized across the US. New Jersey can serve as a unique, virtual testing laboratory, ranking 11th in the US in population, 2nd in the US (after NY) in the per capita rate of COVID-19 deaths, and 5th in total cases and represents a highly diverse state with substantial Black and Latinx minority populations. At Rutgers, we have assembled cohorts of healthcare workers (HCWs) to monitor the spread of COVID-19 and to enroll subjects for clinical and vaccine trials. While building our cohorts, we recognized many URMs serve as HCWs or personal care aides often in lower-income roles. Further, we also found these workers were more often infected compared with those with higher income occupations. Given these observations, we posit that HCWs in occupations at lower incomes would facilitate testing among their house- holds and their communities. In a sense, these HCWs can serve as ambassadors to catalyze community-based COVID-19 testing. NJ HEROES TOO (New Jersey Healthcare Essential WoRker Outreach and Education Study - Testing Overlooked Occupations) proposes to approach URM HCWs who we have identified as index individu- als who will act as ambassadors to help expand testing in their households and extended networks. In Aim 1, we will co-design, develop and implement an innovative, HCW-centric outreach intervention strategy to engage Black and Latinx minority communities. We will explore community perceptions about COVID-19 testing, treatment, and vaccination to design COVID-19 testing materials and messages that are culturally tailored to address concerns of Black and Latinx minority communities. In Aim 2, we will conduct a mixed methods study to evaluate the effec- tiveness and cost of: (1) the HCW-focused outreach intervention strategy versus (2) standard community engaged outreach, working with community based organizations (CBOs). We will explore contextual factors (individual, family, and community) affecting COVID-19 testing implementation outcomes and scalability. The primary out- come will be uptake of COVID-19 testing in the targeted populations. We propose testing with the novel Rutgers Clinical Genomics Laboratory/RUCDR saliva test, the first FDA-authorized diagnostic test using saliva to detect SARS-CoV-2 for non-invasive, home based self-testing. We hypothesize that a participatory outreach strategy approach focused on identified index HCWs will mobilize quicker uptake of testing within community settings than best-practice CBO recruitment approaches. We also hypothesize that recruitment through index HCWs will be more successful for hard to reach participants compared to a traditional CBO approach. The strategy focusing on HCWs could easily be expanded to other front-line and essential workers, making the strategy generalizable and sustainable.

NARRATIVE Through ongoing follow-up of identified under-represented minority members in existing healthcare worker cohorts, we will advance COVID-19 testing in their communities by providing access to testing for their households and extended families. We will compare this outreach approach with other more conventional means of stimulating testing. In light of the continuing COVID-19 pandemic, this research will help us to find better ways to reach members of vulnerable under-represented minority communities to lessen the impact of COVID-19.