Abstract Non-Native Hawaiian Pacific Islanders (PI), defined as indigenous people having origins in Guam, the Commonwealth of the Northern Mariana Islands, American Samoa, Federated States of Micronesia, Republic of the Marshall Islands and Republic of Palau, have among the highest COVID-19-associated morbidity and mortality rates in the U.S. PI also suffer from medical co-morbidities known to increase their risk of severe COVID-19. In addition, PI have poor access to health care, inadequate or no health insurance, live in multi-generational or multi-family overcrowded housing, and have low-paying service jobs that expose them to the infected public. Hawaii is experiencing a dramatic surge in COVID-19, with triple-digit daily counts and more than 10,000 cases. PI, who comprise only 4% of the State’s population, account for 32% of COVID-19 cases. Our long-term goal is to reduce COVID-19 disparities among PI. The overall objective of the proposed research is to use culturally resonant community-engagement strategies to increase the reach and uptake of COVID-19 testing to better understand SARS-CoV-2 infection patterns among PI in Hawaii and on Guam. Our central hypothesis is that culturally appropriate and linguistically correct strategies will increase uptake of COVID-19 testing among PI, resulting in more precise SARS-CoV-2 infection and seroprevalence rates. Our multi-disciplinary investigative team comprises physicians and community health workers, community-engaged researchers and basic and applied scientists. The objective will be achieved by the following specific aims. Specific Aim 1. Develop and evaluate culturally tailored community-engaged strategies to increase COVID-19 testing among PI in Hawaii and Guam. Approach: Engage PI communities to jointly design a strategy with culturally and linguistically appropriate content to promote COVID-19 testing and mplement the strategy and evaluate its effectiveness. Specific Aim 2: Determine SARS-CoV-2 infection patterns in asymptomatic PI in Hawaii and Guam. Approach: Perform COVID-19 RT-PCR and SARS-CoV-2-specific IgG and IgM testing of asymptomatic adult PI in Hawaii and Guam to ascertain infection rates and seroprevalence. A highly committed Community and Scientific Advisory Board, comprising prominent leaders in the PI community and academicians who are dedicated to improving IP health, will provide guidance to design culturally relevant strategies to mitigate COVID-19 disparities among PI. Strong support from the community, academia and government attest to the to the urgency of this Community-Engaged Testing Research Project.

Narrative Non-Native Hawaiian Pacific Islanders (PI), who comprise only 4% of the State’s population, account for 32% of COVID-19 cases in Hawaii. PI are also disproportionately affected by COVID-19 on Guam, the westernmost U.S. Territory in the Pacific. Culturally relevant, community-engaged strategies are urgently needed to improve the reach and uptake of COVID-19 diagnostic testing to better understand SARS-CoV-2 infection patterns among PI in Hawaii and on Guam.