PROJECT SUMMARY/ABSTRACT Racial/ethnic minority, low socioeconomic status (SES), and rural populations suffer profound health inequi- ties across a wide variety of diseases and conditions, as well as a disproportionate burden of the negative health consequences of the COVID-19 pandemic. As of June 2021, the cumulative COVID case rate in Utah per 100,000 was 10,803 among Whites vs. 17,541 among Latinos. The positivity rate was 14% among Whites vs. 24% among Latinos. Similar disparities persist across the nation regarding vaccination rates between urban vs. rural, high vs. low SES, and White vs. non-White populations. Low vaccination rates leave underserved popula- tions at risk for local outbreaks, and more contagious and severe variants. Thus, interventions targeting these populations at the interplay between testing and vaccination are critical for pandemic control. Not only do un- derserved populations experience profound health inequities, but there is also a critical digital divide between high and low resource healthcare systems. Low resource settings are far less likely to adopt Health Information Technology approaches, and often do not have the capacity to implement large scale population health man- agement (PHM) efforts utilizing data analytics and automated patient outreach. Community Health Centers (CHCs) are optimal settings for implementing these PHM interventions to increase the uptake of COVID-19 testing and vaccination among underserved populations. Eleven Utah CHC systems are participating in SCALE-UP II. Their 38 primary care clinics serve over 112,000 unique underserved patients annually. Sup- ported by a RADx-UP Phase I grant (SCALE-UP Utah), we have established a flexible text messaging outreach and patient navigation infrastructure with CHCs to increase testing and vaccine uptake. SCALE-UP II will lev- erage this infrastructure as well as long standing partnerships among the University of Utah Clinical and Translational Science Institute, Association for Utah Community Health, CHCs across the entire state, and the Utah Department of Health. SCALE-UP II will investigate three PHM interventions at the interplay between COVID-19 vaccination and testing: 1) Text Messaging (TM) – bidirectional text messaging with a one-touch response to connect patients to vaccination or mail at-home rapid test kits at no cost for use as needed, 2) Con- versational Agent (CA) – automated, scripted and interactive agent used to mimic human interaction to offer access to at-home rapid test kits, 3) Patient Navigation (PN) – phone call from a community health worker to help address hesitancy and access barriers, and to offer at-home rapid test kits. Two types of PN will be tested: Reactive PN (RPN) will reach out only to those patients who reply YES to a TM/CA message. Proactive PN (PPN) will reach out to all patients, including those who do not reply to a TM/CA message. The specific aims are to 1) Conduct a 2 (TM vs. CA) X 3 (No PN vs. RPN vs. PPN) factorial design assessing intervention effects on testing uptake among unvaccinated adults 2) Examine factors associated with at-home testing and vaccina- tion uptake over time.

PROJECT NARRATIVE Racial/ethnic minority, low socioeconomic status (SES), and rural populations suffer profound health inequities across a wide variety of diseases and conditions, as well as a disproportionate burden of the negative health consequences of the COVID-19 pandemic. SCALE-UP II will provide critical data regarding the impact of pragmatic, scalable population health management approaches to increasing COVID-19 testing and vaccination, and reducing COVID-19-related health inequities. The interventions will be readily available for adoption by other low-resource healthcare settings, and the data will advance population health and implementation science.