Core C Clinical Core

根据社区脆弱性指数，亚拉巴马州被列为最易受COVID-19影响的州， 在达到SARS-CoV-2测试目标方面排名最后的5个州。COVID-19病例率在几个国家高出3倍 相对于伯明翰等大都市地区，亚拉巴马的农村县的SARS-CoV-2检测率为 在大多数农村县，积极性接近或超过20%。有意义的社区参与 制定和实施SARS-CoV-2检测计划对于积极应对社会、道德和 与服务不足的社区有密切关系的行为考虑。亚拉巴马大学伯明翰分校 艾滋病研究中心（CFAR）的研究人员与临床， 社区和公共卫生机构进行创新的艾滋病毒检测和预防研究，并准备 迅速采取行动应对COVID-19疫情。一个动态的COVID-19社区测试 亚拉巴马的战略（COVID COMET AL）将把大量社区知情的艾滋病毒检测知识转移到 解决在服务不足的农村地区、社会经济和卫生部门迅速扩大SARS-CoV-2检测的迫切需要， 弱势群体和黑人/非裔美国人。COVID COMET AL在ADAPT中扎根 为新的环境和人群定制循证公共卫生干预措施的框架，包括 评估、准备和实施阶段。与成熟的临床和 社区检测合作伙伴、区域健康教育中心和其他社区组织， CFAR调查人员将与来自UAB校园的跨学科科学家合作， 目标1（评估）：完善数据驱动的、随时间更新的算法，以确定 亚拉巴马受COVID-19影响最严重的服务不足农村县，目标2（准备）：使用社区参与的顺序混合方法方法，为COVID的定制适应和实施提供信息 在选定实施的受影响严重的农村县实施COMET AL战略，目标3（实施）： 部署反复调整的COVID COMET AL战略，其中包括同伴健康倡导者、社区 卫生工作者和场地为基础的测试，在3个高度影响农村亚拉巴马县的时间，在两个连续的 目标4：评估COVID COMET AL的实施过程， 与社区利益相关者合作，以最大限度地提高计划的覆盖面、有效性和可持续性。使用 准实验、配对、比较时间序列研究设计，SARS-CoV-2检测的时间变化 将比较6个实施县与6个匹配对照县的阳性百分比， 主要结局，检测范围、返回检测结果的时间和接触者追踪的时间为次要结局 结果。基于互动系统框架的COVID COMET AL实施评估 将为这一动态的、数据驱动的公共卫生检测战略的传播提供信息，以最大限度地发挥影响， 解决服务不足的农村社区的差距，并将指导COVID-19疫苗接种战略

Alabama is ranked as the state most vulnerable to COVID-19 by the community vulnerability index, and among the bottom 5 states in meeting SARS-CoV-2 testing targets. COVID-19 case rates are 3-fold higher in several rural counties in Alabama relative to metropolitan areas like Birmingham, with SARS-CoV-2 testing percent positivity approaching or exceeding 20% in a majority of rural counties. Meaningful community engagement in developing and implementing SARS-CoV-2 testing programs is vital to proactively address social, ethical and behavioral considerations germane to underserved communities. University of Alabama at Birmingham (UAB) Center for AIDS Research (CFAR) investigators have long-standing relationships working with clinical, community, and public health agencies to conduct innovative HIV testing and prevention studies, and are poised to act swiftly in response to the COVID-19 pandemic. A Dynamic COVID-19 Community-Engaged Testing Strategy in Alabama (COVID COMET AL) will transfer vast community-informed HIV testing knowledge to address the urgent need for rapid scale-up of SARS-CoV-2 testing among underserved rural, socio-economically disadvantaged, and Black/African American populations. COVID COMET AL is grounded in the ADAPT framework for tailoring evidence-based public health interventions for new settings and populations, and includes Assessment, Preparation, and Implementation phases. In collaboration with well-established clinical and community testing partners, regional health education centers, and additional community-based organizations, CFAR investigators will work together with interdisciplinary scientists from across campus at UAB to conduct the following specific aims: Aim 1 (Assessment): Refine a data-driven, time-updated algorithm to identify the underserved rural counties most impacted by COVID-19 in Alabama, Aim 2 (Preparation): Use a communityengaged sequential mixed-methods approach to inform tailored adaptation and implementation of the COVID COMET AL strategy in highly impacted rural counties selected for implementation, Aim 3 (Implementation): Deploy the iteratively adapted COVID COMET AL strategy, which includes peer health advocates, community health workers, and venue based testing, in 3 highly impacted rural Alabama counties at a time, in two sequential waves, each lasting 6-months, and Aim 4: Evaluate the implementation process of COVID COMET AL in partnering with community stakeholders to maximize program reach, effectiveness, and sustainability. Using a quasi-experimental, paired, comparative time series study design, temporal change in SARS-CoV-2 testing percent positivity will be compared in the 6 implementation counties relative to 6 matched control counties as the primary outcome, with testing reach, time to return test results, and time to contact tracing as secondary outcomes. Evaluation of COVID COMET AL implementation grounded in the Interactive Systems Framework will inform dissemination of this dynamic, data-driven public health testing strategy to maximize impact in addressing disparities in underserved rural communities, and will also guide COVID-19 vaccination strategies