PROJECT SUMMARY The COVID-19 pandemic has caused unprecedented public health and economic consequences globally and in the United States. Long-standing social inequities have been magnified and vulnerable communities have been disproportionately burdened by the pandemic. In Miami-Dade County, Florida, where minority populations experience a high level of social vulnerability, Blacks and Hispanics are overrepresented in COVID-19 related hospitalizations and deaths compared to national rates. Further, Miami-Dade County continues to experience COVID-19 rates well above the state and national levels. Effective vaccines are now available, yet vaccination rates have been persistently lower among U.S. minorities, broadening disparities in COVID-19 outcomes. As such, expanded SARS-CoV-2 testing and vaccine acceptance is critical to mitigating community spread in underserved and vulnerable communities. In this application for Phase II of the RADx-UP project, we will apply the knowledge gained during Phase I to expand community outreach to increase testing and vaccine uptake in minority communities to decrease disparities that contribute to burden of COVID-19 in underserved and vulnerable populations. We propose to continue our RADx-UP community-engaged research by employing new recruitment strategies in conjunction with four community partners to increase reach of testing that include engaging faith leaders and minority health care providers, and placing our mobile testing (and vaccination) unit in church parking areas. We will also conduct a longitudinal study among participants who completed Phase I of the study to assess (a) changes in infection and vaccination status, (b) how the availability of vaccines affects attitudes, beliefs, and behaviors related to testing, (c) changes in SDoH and their impact on COVID-19 testing and vaccine uptake/hesitancy, and (d) the relationship between mental resilience, mental health, and testing and vaccine uptake/hesitancy, and (e) other RADx-UP common data elements. We will also conduct post-infection and post-vaccination studies on antibody production and subsequent infections. For the proposed Phase II application, we have partnered with new community organizations, including Keeping the Faith to Fight COVID-19, an organization of minority health care providers working with Black and Black Hispanic churches, and with the Community Engagement Alliance (CEAL) Against COVID-19 Disparities initiative. We are currently conducting RADx-UP Phase I with established infrastructure and community partnerships to accomplish the aims and enable rapid and measurable impact in access and uptake of SARS- CoV-2 testing by underserved and vulnerable populations. Our community partners have the resources to provide community engagement, public health mitigation, and follow-up care for cases who test positive. Our strategy includes Scientific and Community Advisory Boards; a mobile testing unit; a CLIA-licensed laboratory headed by the PI of this application; data mining and longitudinal approaches for data analyses; and a research team experienced in recruiting and retaining members of the communities targeted in this proposal.

NARRATIVE The aim of this study is to conduct community-based, collaborative research to increase COVID-19 testing and vaccine uptake in hard-to-reach populations, understand the social determinants of health that contribute to disparities in COVID-19 testing and outcomes, and mobilize the community in order to develop strategies to minimize the effects of the current epidemic. In Miami-Dade County, which continues to experience COVID-19 rates well above the state and national levels, socially vulnerable minority populations are at increased risk of COVID-19 infection and poorer health outcomes. We will utilize an established infrastructure and community partnerships to increase testing in the community with a mobile testing unit, and use culturally-appropriate questionnaires to assist in understanding barriers and facilitators to increase uptake of testing and vaccines in the underserved communities.