ABSTRACT This multi-institution team (Emory University, Morehouse School of Medicine, Georgia Institute of Technology), anchored by the Georgia Center for Diabetes Translation Research (P30DK111024) partnership, proposes to leverage and expand on the on-going, RADx-UP funded Project PEACH (P30DK111024), to design and evaluate a home-based COVID-19 testing program with behavioral nudges delivered via mobile phone texts to increase uptake of COVID-19 prevention activities (testing, vaccination, preventive behaviors) in “An Adaptive Intervention Trial of Home Testing with Behavioral Nudges for Improving COVID-19 Testing and Prevention among People Affected by Diabetes.” COVID-19 testing remains a cornerstone in understanding and managing the COVID-19 pandemic. The state of Georgia faces several challenges to COVID-19 management including low vaccine rates, over-extended community health partners struggling to manage both COVID-19 testing and vaccination, decreasing COVID-19 testing numbers, and large populations at elevated risk, including those with or at risk for diabetes, individuals at lower socioeconomic levels, and African American/Black and LatinX communities. In Project PEACH2, we propose to leverage the community partnerships developed and expanded at part of Project PEACH to gather additional information on COVID-19 testing, with a particular focus on at-home testing solutions (Aim 1), using both quantitative (an expansion of the follow-up surveys already being conducted as part of Project PEACH) and qualitative (in-depth interviews with 100 community members, key stakeholders, and community partners) methods. This data, along with the findings of Project PEACH and Georgia CEAL (1OT2HL156812-01/16-312-0217571-66105L), will be used to develop text message, behavioral nudges to promote continued COVID-19 testing, reporting and preventive behaviors including vaccination targeted to participants’ race/ethnicity, sex, age, vaccination status, and testing history. We will then evaluate (Aim 2a) the uptake, usage, and views of a home testing platform (provision a single home COVID-19 test kit for each household family member, collection of test results via an online reporting system, and targeted behavioral nudges delivered via text messages) in a randomized community- based, adaptive intervention trial (n=600) targeting individuals affected by diabetes through collaborations with community partner sites (faith- and community-based organization, the Grady Diabetes Clinic, COVID-19 community testing and vaccine distribution sites). We will also assess (Aim 2b) how the home testing platform affects vaccine uptake and hesitancy among study participants and family members. This study will build on the successful community-academic partnerships created through Project PEACH to further promote COVID- 19 testing among the most vulnerable communities in Georgia. Lessons learned can be disseminated to other at-risk communities and can be adapted to promote home-based testing for other conditions.

NARRATIVE SARS-CoV-2 testing remains an important priority for long-term pandemic control; however shifting needs and priorities of the U.S. population have led to decreasing testing rates, even in states like Georgia where COVID- 19 vaccine uptake is low. To enable better adherence to long-term COVID-19 testing and preventive behaviors, we propose a study to understand, design, and test in a randomized, adaptive intervention trial of 600 adults affected with diabetes, at-home testing with or without individually-targeted, text message, behavioral nudges targeting COVID-19 testing uptake and preventive behaviors, including vaccination.