Abstract The racial/ethnic disparities in Northwest Arkansas (Benton and Washington Counties) were so stark that the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health sent investigators. The CDC's report documented that 45% of all adult cases in Northwest Arkansas were among Hispanic/Latinx patients and 19% were Native Hawaiian/Pacific Islander (NHPI) patients.1 Hispanic/Latinxs and NHPIs only account for 17% and 2.4% of the two-county population, respectively. COVID-19 deaths in Northwest Arkansas were also disparate across race and ethnicity. NHPI deaths were estimated to be more than 200 per 100K — much higher than the overall death ratio for the county of 5.10 per 100K, as well as the death ratio for Whites of 4.03 per 100K.1 Among racial/ethnic minorities, the Northwest Arkansas NHPI population stands out as having much higher odds of death from COVID-19.1 Even with the increased availability of COVID-19 testing and vaccination, barriers remain for racial and ethnic minority populations. While the availability of COVID-19 testing has improved, disparities in testing across race, ethnicity, and socioeconomic status continue to stymie efforts to reduce COVID-19 morbidity and mortality. Hispanic/Latinx and NHPIs have also experienced increased discrimination related to COVID-19. Our preliminary research documents that these experiences with discrimination may reduce Hispanic/Latinx and NHPI willingness to get tested. Minority populations are more likely to distrust traditional approaches to health care. In addition to concerns with trust and discrimination, Hispanic/Latinx and NHPI community members face access barriers including long-working shifts, inability to take off work for health care, and lack of insurance. Self-testing for COVID-19 holds promise in overcoming the barriers of trust, discrimination, and health care access. Yet no studies have tested the best distribution methods for self-testing among Hispanic/Latinx and NHPI. This study fills that gap and holds promise for increasing sustained access for Hispanic/Latinx and NHPI communities and reducing significant COVID-19 disparities in incidence, hospitalization, and death. Our specific aims are: Aim 1. Leverage and fully engage our long-standing community-based partnerships to overcome barriers of trust, discrimination, and health care access to increase the use of COVID-19 self-testing. Aim 2. Implement and evaluate access and uptake strategies of two self-testing distribution approaches (local community clinics and community-based non-profit organizations) to understand effectiveness and impact for vulnerable populations. Aim 3. Fully collaborate with the RADx-UP Coordination and Data Collection Center (CDCC) and other RADx sites.

PUBLIC HEALTH RELEVANCE The increase in COVID-19 self-testing holds promise in overcoming the barriers of trust, discrimination, and health care access Native Hawaiian and Pacific Islanders (NHPI) and Hispanic/Latinx experience. The interdisciplinary team will implement and evaluate access and uptake strategies of two self-testing distribution approaches (local community clinics and community-based non-profit organizations) to understand effectiveness and impact for vulnerable populations. This study fills gaps in the research related to self-testing and holds promise for increasing sustained access for NHPI and Hispanic/Latinx communities and reducing significant COVID-19 disparities in incidence, hospitalization, and death.