To help reduce COVID-19-related health disparities in vulnerable populations in Texas, a multi-institutional team of researchers led by The University of Texas Health Science Center at Houston (UTHealth) will identify disease hotspots and testing deserts in three racially diverse areas, and then develop and evaluate intervention strategies to increase COVID-19 testing.
The study, which is funded by a $5 million grant from the National Institutes of Health to UTHealth through the Center for Clinical and Translational Sciences (CCTS), will focus on three areas of the state with high infection rates - South Texas, Houston/Harris County, and Northeast Texas. Study partners include The University of Texas Rio Grande Valley (UTRGV), and The University of Texas Health Science Center at Tyler (UTHSCT).
"Finding the reasons behind the disparities in testing is a first step to reducing those disparities in vulnerable populations," said David McPherson, MD, principal investigator for CCTS-related research and chair of the Department of Internal Medicine at McGovern Medical School at UTHealth. "By quickly identifying those who have COVID-19, we can reduce spread, which is critical for saving the lives of those most affected by the virus."
The study is funded through the Rapid Acceleration of Diagnostics (RADx) initiative. As part of the initiative, the RADx Underserved Populations (RADx-UP) program will support research that aims to better understand COVID-19 testing patterns among underserved and vulnerable populations; strengthen the data on disparities in infection rates, disease progression, and outcomes; and develop strategies to reduce the disparities in COVID-19 testing.
UTHealth is one of 32 institutions across the country that received an NIH award through the RADx-UP program to support projects designed to rapidly implement COVID-19 testing strategies in populations disproportionately affected by the pandemic. These groups include African Americans, American Indians/Alaskan Natives, Latinos/Latinas, Native Hawaiians, older adults, pregnant women, and those who are homeless or incarcerated.
"It is critical that all Americans have access to rapid, accurate diagnostics for COVID-19, especially underserved and vulnerable populations who are bearing the brunt of this disease," said NIH Director Francis S. Collins, MD, PhD. "The RADx-UP program will help us better understand and alleviate the barriers to testing for those most vulnerable and reduce the burden of this disease."
The study will seek to understand why vulnerable populations, such as those with medical comorbidities and people experiencing homelessness, have significant disparities in coronavirus infection and mortality rates. Underserved populations such as Blacks, Hispanics, those who live in rural areas, and underinsured individuals, have higher rates of comorbid conditions including diabetes, obesity, asthma, and hypertension, which places them at risk for severe disease. In Texas, Hispanics make up 29.4% of the population, but 40.1% of COVID-19 cases, and 47.9% of confirmed fatalities, according to the Texas Department of State Health Services.
"The long-term goal is to reduce COVID-19-related disparities and improve health and quality of life of underserved populations," said Maria E. Fernandez, PhD, lead co-principal investigator of the study and the Lorne Bain Distinguished Professor in Public Health and Medicine at UTHealth School of Public Health. "One of the coolest components of the study is the community engagement piece where we will meet with people in the neighborhoods most affected and prioritize together the education and strategies needed for intervention."
The study has three overall aims:
- Identify priority areas based on disease hotspots, access to testing, and prevalence of chronic conditions.
- Identify and examine relationships among the various organizations in these priority areas that are providing services.
- Use data from the first two aims to prioritize intervention activities, tailoring and implementing the materials, methods, and strategies to increase testing.
"We want to not only encourage people to get tested, but for them to follow up on results and, if needed, practice behaviors to protect themselves and others, and participate in contact tracing," Fernandez said.
To identify priority areas, researchers will use data from regional health departments and hospital records to estimate real-time testing availability and use by residents. They will also examine the incidence and test-positive rate. The higher the positivity rate, the more likely that testing is low in a particular area.
For the second aim, by looking at the relationships among organizations providing services, researchers hope to maximize system-level performance to increase testing.
Community engagement is integral to the study and in the third aim, is used to develop, implement, and evaluate adaptive intervention approaches in real time that correspond to rapidly changing conditions and needs of priority communities to increase testing. Researchers will study whether the engagement approaches and the resulting interventions increase COVID-19 testing and follow-up.
"The integration of these aims and how they influence each other is unique and exemplifies how public health can be practiced. We work to understand the issue and then intervene in a way that uses data to make best decisions," said Belinda Reininger, DrPh, professor and regional dean of UTHealth School of Public Health in Brownsville. "The areas where we are working are in high need because of health disparities. The proposed study will test strategies to improve access to testing across rural, border, and inner-city populations."
Fernandez said the team will use "Community Just In Time Interventions," an innovative concept that identifies priority areas dynamically using rapidly changing data, so that strategies can be quickly tailored to meet the needs of the community.
The work will bring together researchers and community partners for a truly collaborative approach. Co-lead investigators for the study are Fernandez; Reininger, who is in the Department of Health Promotion and Behavioral Sciences; and Marcia C. Otto, PhD, assistant professor in the Department of Epidemiology, Human Genetics, and Environmental Sciences at UTHealth School of Public Health.
The lead investigator for UTRGV is John M. Thomas III, PhD, assistant professor in the Department of Biology, College of Sciences; and for UTHSCT is Paul McGaha, DO, MPH, chair and associate professor in the Department of Community Health for the School of Community and Rural Health. Numerous researchers from the partner institutions are involved to ensure a multidisciplinary approach is used to address this complex issue.
"This study will have great significance for the underserved populations in Northeast Texas," McGaha said. "Many do not have access to COVID-19 diagnostic testing and services. As the only health science center in the area, we want to assist our regional communities in responding to the coronavirus pandemic."
Community and health care organizations in Houston participating in the study include UT Physicians, Avenue 360, Healthcare for the Homeless, HOPE Clinic, and Spring Branch Community Health Center. Community partners include the City of Houston, 2-2-1 Texas/United Way of Greater Houston, Harris County Public Health, Greater Houston Partnership, The University of Texas MD Anderson Cancer Center Department of Health Disparities, Cameron County Public Health, City of Brownsville, Northeast Texas Public Health District, Pro-Salud, Texas Association of Health Centers, and Baker Ripley. Laboratories include UTHealth Pathology and Baylor College of Medicine.