Abstract: This RADx-UP Phase II proposal, “Social network diffusion of COVID-19 prevention for diverse
Criminal Legal Involved Communities”, will implement a situation appropriate COVID-19 testing and
vaccination social network diffusion intervention – C3 – building upon RADx-UP Phase I lessons and
successful social network prevention interventions developed previously by the research team. C3 Criminal
Legal Involved (CLI) populations encompass those non-incarcerated who have experienced recent arrest,
incarceration, probation, parole or diversion programs such as drug courts. While increases in COVID-19
testing have been observed among this group, there remain members with limited testing history as well as
individuals who are vaccine hesitant. COVID-19 prevention messaging can no longer be simplified to
“everyone test and/or everyone vaccinate” as testing and vaccination decisions among community members
are sensitive to personal histories (i.e., prior infection), local infection rates (i.e., low rates) and
testing/vaccination availability. As COVID-19 prevention efforts have become more complicated (i.e., test if
exposed), people tend to focus on the messenger, and particularly those that are close to them. Personal
connections and communications within existing personal network structures, such as families, friends and
other trusted acquaintances represent the cornerstone to increase situation appropriate testing and
overcoming COVID-19 vaccine hesitancy. C3 builds upon RADx-UP I, by using a network diffusion approach
facilitated through motivational interviewing purposefully geared to mobilize one’s own organic social network
to increase context appropriate testing and vaccine uptake. Through this process we will maximize the primary
benefit and impact of this type of intervention which also has the intended effect of increasing likelihood that
the messenger themselves will undergo the same behavior change that they have been trained to promote.
We will leverage infrastructure developed in RADx-UP Phase I, which includes 4 high-impact sites across the
Central US from Phase I: Baton Rouge LA, Little Rock AR, Indianapolis IN, and Chicago IL. We will utilize
established engagement efforts already in place and continue to fully integrate communities in the strategic
application of the intervention. We will use the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and
Maintenance) framework to guide implementation. C3 aims to: Aim 1a. Test the efficacy (3-month situation
appropriate testing or vaccination) of a network diffusion intervention (C3) versus an existing COVID-19 testing
and vaccine linkage to care intervention among: 1) primary study participants (primary outcome); and 2)
secondary study participants connected to primary participants (secondary outcome) using a RCT design. Aim
1b. Explore the mechanisms for differential intervention effects at the individual and network-level that may
increase situation appropriate testing and/or vaccination uptake. Aim 2. Examine key RE-AIM components in
real time tied to the implementation of the network diffusion intervention (C3).
