The Johns Hopkins Center for American Indian Health has been awarded a prestigious Rapid Acceleration of Diagnostics (RADx) grant from the NIH to aid COVID-19 prevention through safety practices and reducing time from symptoms to testing in the White Mountain Apache Tribe and Navajo Nation, two Native American tribes disproportionately affected by the pandemic.
The Center is an ideal partner for RADx Underserved Populations (RADx-UP), which aims to reach communities hard-hit by the pandemic including Native American people. Since April, the Center has helped the two tribal nations respond to the pandemic, including increasing testing capacity, contact tracing, home-testing with rapid results, and food, water, and resource support for families in quarantine or isolation.
Working with tribal divisions of health and the Indian Health Service, the Center uncovered barriers as well as opportunities to improve prevention practices, testing, isolation, and care-seeking among two groups of people:
- Elders have the highest case fatality rate in both communities and are deeply revered as teachers of cultural practices and languages. A significant portion of Elders are currently hesitant to get tested due to cultural beliefs and fear, and can be slow to seek care when symptoms worsen.
- Young adults 18-34, particularly those engaged in substance use, make up the biggest proportion of cases, are less likely to social-distance or isolate, and are more transient, moving among multi-generational households.
This project will apply a randomized “2x2 factorial design” to evaluate two interventions for Elders and young adults:
- A culturally tailored, age-specific Motivational Interviewing (MI) intervention aims to promote testing, protective behaviors, and care-seeking and isolation—hard to achieve in any home, much less multi-generational homes that are often low-income.
- A COVID-19 symptom text-based monitoring system aims to shorten the amount of time between when people begin to experience symptoms and go for testing.
Improved testing via RADx could help end the acute phase of the pandemic
While treatment and vaccine technologies for COVID-19 are still under study, it’s essential to rapidly and accurately identify people infected with the virus and help people to isolate in order to end the acute phase of the pandemic.
To respond to this challenge, the NIH launched RADx, a national call to advance innovative ideas for new COVID-19 testing approaches and strategies. One of the four RADx components, RADx-UP seeks to better understand COVID-19 testing patterns and implement strategies or interventions with the potential to rapidly increase reach, access, acceptance, uptake, and sustainment of FDA-authorized and approved diagnostics among populations at increased risk for COVID-19 in underserved geographic locations.
RADx-UP builds on successful community-based participatory partnership
Following the Center’s Community Based Participatory Research approach, this project will uncover factors that currently lower testing rates while building on Indigenous strengths to create interventions that strengthen Native communities’ prevention response. This study aims to uncover what combination of Motivational Interviewing or symptom tracking can accomplish aims including:
- Promote practices to decrease community spread
- Decrease delays in testing after an individual is exposed to someone infected with COVID-19
- Decrease delays in testing after a person shows COVID-19 symptoms
- Encourage people to isolate after testing positive
- Encourage people to seek health care if experiencing COVID-19 symptoms
The study will also explore if factors such as cultural identity and connectedness, substance use or mental health issues like depression, age, or sex help or hinder the response to the proposed interventions. If aims are achieved, this project will make advances in diagnostic testing strategies for some of the most underserved and high-risk populations in the U.S. The project study is expected to start later this winter after all approvals are in place.