NIH program to provide culturally relevant outreach, follow-up to vulnerable populations
Editor’s note: This story is being highlighted in ASU Now’s year in review. Read more top stories from 2020.
Arizona State University has received a $4.7 million federal grant to boost testing for COVID-19 in underserved communities around the state.
ASU’s Southwest Interdisciplinary Research Center won the grant Sept. 30 for an intensive project to provide education, saliva COVID-19 tests and follow-up care to 10 communities around Arizona. The work will be done in conjunction with the Global Center for Applied Health Research at ASU; the Biodesign Institute at ASU, which developed the saliva test; and the Equality Health Foundation, a Phoenix-based organization that works to overcome disparities in health care.
ASU won the grant because it already works with partners in underserved communities, according to Flavio Marsiglia, founder and director of the Global Center for Applied Health Research and Regents Professor. The two research centers are part of the Watts College of Public Service and Community Solutions at ASU.
“I’m proud that as an institution, when we talk about community embeddedness, it’s not an empty phrase,” he said. “In fact, we got the grant because we have the scientific capacity but also because we have this strong connection to the community.”
The ASU project will identify “testing deserts” in Arizona based on epidemiological data from the state, and then provide 29,000 tests as part of an intensive outreach and follow-up effort, led by the Equality Health Foundation. Health workers from each community will be trained by ASU’s Biodesign Institute Clinical Testing Laboratory to facilitate the saliva tests. People who test positive will receive medical care, education on how to keep themselves and their families safe, and food, housing and employment assistance, if needed.
ASU is among 32 institutions, including Harvard, Yale and Brown universities, that received a total of nearly $234 million from NIH to measure and promote COVID-19 testing in underserved communities across the U.S. The pandemic has disproportionately affected American Indian, Black and Latino communities.
The NIH projects will help people in the Northern Plains, Lakota, Cherokee and Navajo tribal nations, native Hawaiian populations, urban Indians, pregnant women in Mexico-U.S. border communities, residents of territories such as the U.S. Virgin Islands, transgender people, diabetics, children with intellectual disabilities and populations in nursing homes, public housing and correctional facilities. Various projects will test the effectiveness of outreach by social media, text messaging, mobile vans and many different types of community health workers.
The NIH award came one week after ASU received a $6 million state contract to develop a 20-minute saliva test for COVID-19. In May, ASU’s Biodesign Institute developed a saliva test with results delivered in 24 to 48 hours, which is the one that will be used in the new NIH project.
“This is an inspired, collaborative effort in the best tradition of SIRC, bringing together community members to address a gap in the service delivery system in a time of crisis,” said Jonathan Koppell, dean of ASU’s Watts College of Public Service and Community Solutions.
“There is important work to be done today and very important new knowledge will emerge from it."
'Everyone will be welcome'
Earlier this year, the Equality Health Foundation formed a multiagency coalition to rapidly respond to COVID-19 in vulnerable populations. With the $4.7 million, that coalition and the advisory board of the Global Center for Applied Health Policy will together choose 10 communities for intervention.
“Then we’ll have a big community event in that community,” said Marsiglia, who is the principal investigator The co-principal investigators are: Hyunsung Oh, assistant professor in the School of Social Work; Susan Pepin, managing director of health and clinical partnerships, Knowledge Enterprise Development, and Tomás León, senior vice president, Equality Health Foundation. The co-investigators are: Li Liu, assistant professor of biomedical informatics in the College of Health Solutions, and Stephanie Ayers , associate research director of the School of Social Work.of the project.
“People will register, and they’ll come by car or walking or bicycle. Everyone will be welcome.”
The point of the project is that outreach will be culturally relevant to that community. For example, all written materials will be bilingual and easily understandable.
“One size doesn’t fit all,” Marsiglia said.
“In the past, Mexican American families have gone to testing sites and taken the whole family to be tested because they live in small quarters and share spaces.
“Some of the testing sites say, ‘We don’t test children,’ or, ‘Why are there so many here?’ And they send them away.”
The ASU project will welcome whole families.
“Everyone will get tested and get that education.”
After the big testing event, the team will follow up with people who registered but didn’t show up and those referred by others.
“Somebody might say, ‘I have a cousin who would benefit from testing but doesn’t want to come,’” he said.
“Then we’ll have small events in public places, such as Safeway or church parking lots, more targeted to certain pockets in the community,” he said.
“And the third level is that we’ll go to people's homes to do testing – home visits by community health care workers,” Marsiglia said.
The goal is to reach as many people as possible, said Tomás León, senior vice president of Equality Health Foundation.
“We can catch people who didn’t show up because of transportation issues or health issues,” he said.
“We’re breaking down that last mile of barriers for people who need to get tested.”
People who test positive will be referred to doctors, and also will get other support they need, such as housing, food and employment assistance, León said.
The entire project is setting the stage for a vaccine, which might become available within the two-year life of the grant.
“Then all these networks will be activated,” Marsiglia said.
“These same communities will be underserved in vaccine distribution and we want to be sure that doesn’t happen.”
Vulnerable communities can include places where affordable housing is an issue and many people live together.
“The kinds of jobs people in these communities have tend to be very front-line jobs that are in constant interaction with the public,” Marsiglia said.
On the Navajo nation, many houses don’t have running water, making it difficult to frequently wash hands.
“They are not to blame,” he said. “Everyone wants their kids to be healthy.”
After the testing phase, the team will compare two groups who tested positive – those who received the outreach and follow-up in the NIH program and those who didn’t.
“We want to see if the more tailored approach like the one we’re doing will get better results – that people take care of themselves, quarantine, and use masks more often,” he said.
“We want to see if change is permanent and consistent when you really reach out and become culturally in tune.”
Customizing outreach to individual communities takes time but is crucial, Marsiglia said.
“Sometimes people say, ‘That’s too complicated,’ but then we leave whole groups of people on the side,” he said.
“Every life is important.”