Leveraging Social Networks to Increase COVID-19 Testing Uptake: A Comparison of Credible Messenger and Chain Referral Recruitment Approaches

Aims. Building on the expertise and community out-reach infrastructure of two community-based organizations (CBOs), Argus Community Inc. and Alliance for Positive Change, and following a CBPR approach, investigators propose to take two implementation strategies that have been proven to increase the reach, access, and uptake of HIV testing and related services, and adapt them to support the uptake and sustainability of point-of-service (POS) onsite COVID-19 testing in CBOs that target the underserved population of those who use opioids and other substances. Guided by social cognitive theory, Andersen's model of health care access and the EPIS framework, the specific aims are to:

(1). Adapt two implementation strategies to support COVID-19 testing uptake and sustainability, adapting elements of existing efficacious social network-based interventions via a CBPR approach; (2). Examine and compare the efficacy of two sets of implementation strategies on (i) reach, (ii) testing uptake, (iii) service delivery and (iv) sustainability for individuals who use opioids and other drugs. Use of data drawn from Healthix, a public health information exchange, will supplement this comparison by generating a baseline of participant prior testing and health behavior to determine access to underserved populations as well as long-term influence on future testing behavior; and (3) Elucidate and compare the system/organizational-, staff-, and individual-level factors that influence implementation of the strategies to develop a plan for dissemination and scale-up in other CBOs who serve opioid and other substance using individuals in NYC.

Settings. Alliance for Positive Change and Argus Health Inc have well-established partnership with members of the parent grant team following partnerships on numerous initiatives targeting HIV, HCV and STIs prevention, testing and treatment for over 20 years. Argus and Alliance have had a combined presence in the communities of Washington Heights, Harlem and the South Bronx for over 50 years, and have subsequently developed considerable trust, support and "credibility" within these communities.

Design, Sample Size and Randomization. Two distinct social network recruitment strategies will be adapted and compared. Guided by the EPIS framework, SCT, and Andersen's Model, this 2-year study will comprise three phases. In Phase 1: Adaptation of outreach recruitment strategies, investigators will work with our project CAB, via a CBPR approach, to adapt chain-referral and POL strategies for uptake of COVID-19 testing, to finalize recruitment and on-site testing protocols. In Phase 2: Strategy Efficacy Trial and Implementation Evaluation, investigators will compare the two strategies in a cross-over design at two CBOs, with initial strategy assignment randomly determined and rolled out for 4 months before cross-over. Investigators will examine the impact of each strategy on (i) reach, (ii) COVID-19 testing/repeat testing, and (iii) service delivery among those who test positive for COVID-19. In Phase 3: Sustainment, CBOs will implement the strategy with more favorable outcomes in Phase 2, and investigators will examine their sustainment of the program. Implementation evaluation will identify participant-, staff-, and organizational-level factors that influence the feasibility, acceptability, and sustainability of each strategy in the CBOs.

Phase 1: Adaptation of Outreach Strategies. Investigators will employ a CBPR-guided approach to adapt the social network-based outreach strategies. To do this, investigators will hold four 1-hour working groups with our CAB. All CAB members will be reimbursed for their time. These groups will address how to best employ the different strategies to reach our target population and motivate testing uptake. Protocols will be shaped by findings from working group meetings and shared back to the CAB who will provide feedback to inform changes in content and format, and help identify markers of success and potential challenges.