Over 4 million people have been infected with the SARS-CoV-2 virus and more than 460,000 have died. Novel mitigation strategies and community level public health interventions are critical to stop the spread of this virus. The goal of frequent home testing is to identify SARS-CoV-2 index cases early, trigger isolation and quarantining precautions, and ultimately decrease community transmission. We will evaluate a public health intervention combining frequent at-home testing with broad community engagement strategies, to reduce SARS-CoV-2 virus community transmission and conduct a study in a cohort of the population to understand the human behavior factors affecting viral testing. This approach will allow us to answer questions regarding community transmission for the SARS-CoV-2 pandemic as well as additional questions relevant for implementation of public health interventions in future pandemics. We will partner with the CDC to evaluate community dissemination of 2 million rapid tests in a public health intervention of rapid, twice weekly at home testing in up to 3 communities 1) with high prevalence of disease 2) that have reliable publicly available outcome data and 3) that overlap with current RADx-UP sites to leverage the robust infrastructure of the CDCC and support community engagement through the testing projects. To evaluate whether frequent rapid at-home testing strategy decreases community transmission of and morbidity from SARS-CoV-2 over a 5-week period, our primary outcomes include measures of community transmission (hospital capacity/health care utilization, composite measure of community transmission, wastewater surveillance), and morbidity (hospitalizations, covid-like illness). Our secondary outcomes include (community mobility, PCR turn-around time, ICU admissions, contact tracing episodes, and percent test positivity). In addition, we will conduct a substudy to assess behavioral determinants of testing (social interaction, health behaviors, healthcare utilization, prevention knowledge and vaccine attitudes) using a smart phone application with consenting participants in the public health intervention.

At home testing will provide answers to questions regarding community transmission for the SARS-CoV-2 pandemic as well as additional questions relevant for the implementation of public health intervention in future pandemics.