Vulnerable populations including those with medical comorbidities, people living in rural
settings and minorities experience significant COVID-19 disparities. Additionally, Hispanics and
Blacks are significantly more likely to be infected and hospitalized when compared to White,
Non-Hispanics. The proposed study builds on RADx-UP Phases I & Phase II work reaching
these populations in three racially diverse regions: Houston/Harris County, South Texas, and
Northeast Texas to increase SARS-CoV-2 testing, vaccination, and risk mitigation behaviors to
reduce COVID-19 morbidity, mortality, and inequities among underserved populations in Texas.
The proposed study leverages the partnerships and resources of the Center for Clinical and
Translational Science (CCTS) including long-standing community partnerships. Phase III will
include mixed methods and community-engaged approaches to inform adaptation of our
existing (and the development of new) multilevel intervention messages, materials and
strategies with a focus on increasing rapid SARS-CoV-2 testing. It will also include a broader
focus on addressing the social determinants of health (SDOH) and an emphasis on combating
misinformation. Innovative elements of the proposed study include testing a novel approach to
optimize community engagement that uses real-time data to inform intervention adaptation and
implementation, using advances in social computing and machine learning to better understand
patterns of misinformation in social media, and using multilevel social network analysis
techniques to increase intervention agility, intensity, and reach. This project has three aims:
Aim 1) Expand existing sources of population-based COVID-19 surveillance data to quantify
infection, testing and vaccination trends in three Texas regions, and use innovative methods to
inform and evaluate the proposed interventions; Aim 2) Adapt, implement and evaluate the
multilevel community just-in-time adaptive intervention (MC-JITAI) developed in Phase II to
increase SARS-CoV-2 testing, mitigation behaviors, and COVID-19 vaccination, among
underserved and vulnerable populations in three regions of Texas; and Aim 3) Determine the
feasibility and effectiveness of leveraging multilevel social networks to improve SARS-CoV-2
testing and COVID-19 vaccination, in three regions of Texas.
