Improving COVID-19 Vaccine Uptake Among Racial and Ethnic Minority Groupswith Rheumatic Diseases

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PROJECT SUMMARY Black and Latinx individuals are at higher risk for certain autoimmune rheumatic diseases (AIRDs) and have experienced worse COVID-19 outcomes compared to their white counterparts. The American College of Rheumatology recommends beyond the initial COVID-19 vaccination, subsequent COVID-19 vaccine doses to complete the primary vaccination series and a booster dose in people with AIRD. Yet, historically, overall vaccine uptake among people with AIRDs has been low, and this vaccine reluctance has extended to COVID- 19 vaccination. This proposal will harness community-engaged methods to develop and test the effectiveness of a multi-modal intervention that combines “storytelling” videos and patient navigation to increase uptake of recommended COVID-19 vaccination among Black and Latinx AIRD patients in two distinct US geographic regions. Aim 1 will develop a multi-modal intervention that includes a) “storytelling” videos we will produce with vaccinated Black or Latinx patients with AIRDs narrating their COVID-19 vaccination experiences, and b) a patient navigation approach to encourage recommended COVID-19 vaccination. Navigators will be trained using virtual case simulation to discuss up-to-date guidance and provide logistical support for vaccination. In Aim 2a we will recruit 1,170 racial and ethnic minority patients from 4 rheumatology clinics in the Southern and Northeastern U.S. to participate in this patient-level, randomized, controlled, parallel group trial. Participants will be randomized to receive at the routine clinic visit either “storytelling” OR an “attention-control” plus usual care. At the clinic visit, coordinators will invite participants to view “storytelling” videos on tablet computers deployed in a private clinic area. At 2 days after the clinic visit, the navigators will contact each participant remotely (phone/video calls) to provide customized assistance for vaccination. A second contact will occur ~2 weeks later. We will examine the differences in rates of COVID-19 vaccine receipt between racial/ethnic minority participants with AIRD exposed to our multi-modal intervention versus an “attention-control” video (focused on the merits of a balanced diet/exercise on health status) plus usual care. We will measure rates of receipt of subsequent COVID-19 vaccination at 3 months after the clinic visit using extant linkages to state vaccination records (primary endpoint). We will measure via surveys COVID-19 vaccine confidence, influenza vaccine uptake (self-report) as a proxy for intervention effect on vaccination behavior for other vaccines, self- efficacy, and social health. We will explore whether insurance status and education moderate COVID-19 vaccine uptake. In Aim 2b, using surveys and semi-structured interviews, we will assess how intervention components achieved their effects to inform future scale-up of our intervention. Beyond our innovative approach and experienced team, a key strength of our study is its generalizability since we are including two geographically distinct regions with substantial ethnic/racial diversity in their populations that deliver care to many uninsured, Medicaid, and other historically marginalized groups.