Prior epidemiologic research by our team documented stark racial and socioeconomic disparities in COVID-19
case prevalence, testing rates, and test positivity in Alabama. COVID-19 testing in vulnerable populations is
paramount for current and future pandemic control and critical for reducing COVID-19 disparities. Reducing
Ethical and Social Prejudicial Effects of COVID-19 Testing in Underserved Populations (RESPECT-UP) aims
to understand and address the social, ethical, and behavioral factors surrounding COVID-19 testing in highly
vulnerable urban and rural African American communities in Alabama, in the top quintile of the Social
Vulnerability Index. The targeted geographic areas in Jefferson County (urban) and Dallas County (rural) have
some of the lowest vaccination rates in the country, making their population a very high risk for future disease
outbreaks. In Aim 1, we employ a sequential explanatory mixed methods design to assess social and structural
barriers to COVID-19 testing while exploring stigma, discrimination, and behavioral factors that impact COVID-
19 testing intentions in the context of vaccine availability. In Aim 2, we develop actionable strategies to reduce
inequities in COVID-19 testing and produce RESPECT-UP Toolkits tailored to various organizational and
community contexts. In Aim 3, we deploy the toolkits and evaluate their effectiveness in urban and rural
primary care settings; implementation in other settings will be evaluated in future efforts. Informed by a Social
Determinants of Health framework and the Theory of Planned Behavior, this systematic approach to
understanding the full continuum of structural, social, ethical, and behavioral determinants of COVID-19 testing
generates important new scientific knowledge. Furthermore, working together with community stakeholders in
a participatory way, the project produces concrete multi-level solutions – RESPECT-UP Toolkits – that can be
used by organizations, communities, and policy makers to improve the equity, access, and uptake of current
COVID-19 testing and be ready to deliver equitable, non-stigmatizing, and non-discriminatory testing in future
outbreaks. The Toolkits can be adapted to a variety of populations and settings, which further increases their
value, generalizability, sustainability, and potential impact. RESPECT-UP is supported by a community
coalition of partners with a long-standing history of collaboration, and coordinates efforts with other COVID-19
research initiatives to maximize resources, community partnerships, and collected data.
