SKC COVID-19 home-test study will be seeking 200 volunteers

If you could have a home-based test kit for the virus that causes COVID-19, what kind of education and support would be most helpful to you? A research team at Salish Kootenai College soon will start seeking 200 volunteers who live within the Flathead Indian Reservation to evaluate the effectiveness of home-based testing strategies. Recruitment of volunteers is currently planned for March.

SKC Extension Director Virgil Dupuis and Life Sciences faculty member Dr. Wendy Westbroek are part of a two-state research collaboration to help determine the most effective home-testing strategy to best serve underserved populations when home tests are expected to become available this spring.

The Center for American Indian and Rural Health Equity (CAIRHE) at Montana State University has been awarded a two-year grant from the National Institutes of Health to examine COVID-19 testing strategies among underserved populations in Montana and Washington.

CAIRHE and MSU will lead the study, partnering with the University of Washington’s School of Medicine and Institute of Translational Health Sciences (ITHS); the Fred Hutchinson Cancer Research Center in Seattle; and Salish Kootenai College and the Confederated Salish and Kootenai Tribes. A local community advisory board will be involved in all stages of the research in each study location.

“The significant health disparities that already existed among Native and rural communities in Montana and our region have become even more pronounced with COVID-19,” physician Alexandra Adams, director of CAIRHE and principal investigator for the new study, said in a press release. “Because of poor access to testing in those areas and high rates of existing chronic disease, we are very concerned about the significant impact of COVID-19 in these communities.”

The Washington team will work with their community partners in Yakima Valley, home to a large Latino population that includes migrant agricultural workers.

The Montana team, led by Adams and Selena Ahmed at CAIRHE, with Dupuis and Westbroek at SKC, will use CAIRHE’s existing research partnerships on the Flathead Reservation to study testing approaches among the indigenous and non-indigenous population.

“These communities are very similar in the rural barriers to testing that they face,” Adams said. “And they’re connected by seasonal farm workers who travel between the two areas, possibly bringing the coronavirus with them.”

In each of the two locations, the project will conduct a 200-person randomized trial this spring that compares two approaches to home-based COVID-19 testing, Adams explained. In the “active” approach, local health educators who are trusted community members will deliver tests to study participants and provide assistance. In the “passive” approach, participants will instead receive test kits by mail or at a pick-up location. All participants will receive culturally adapted printed and video instructions, as well as a survey on their current symptoms and medical conditions. Those who test positive for COVID-19 will be referred to local public health agencies for contact tracing and clinical follow-up.

“It’s our hypothesis that home-based testing will be more efficient, have a greater impact and be better accepted using the active delivery of test kits by trusted community members,” Adams said.

Currently the research team is waiting to see if tests suitable for home use, with results immediately available to the participant, will receive U.S. Food and Drug Administration approval and be commercially available in time for the study. If not, home-based sampling will be analyzed in an alternative way.

Prior to the testing trial, a series of interviews and focus groups in each study community will explore individuals’ knowledge of COVID-19 and preventive measures; beliefs about COVID-19 testing; and cultural factors that affect their testing decisions. Adams said this data will help study leaders determine the cultural, social, behavioral and economic barriers to testing that exist in those communities.

“Using this information, we can develop the educational materials that will accompany the test kits so that they’re culturally appropriate and most effective for each community.”

Following the trial, the joint study team will evaluate the acceptability and feasibility of the home-based testing approaches through participant surveys. That information will allow CAIRHE and its partners to create testing protocols that could significantly increase home-based testing among Native and Latino communities nationwide, Adams said.

“At the end of the day, our goal is to decrease the devastating impact of COVID-19 in these vulnerable rural areas,” she said.

The grant of $1,797,140 to CAIRHE is part of the NIH’s $1.4 billion Rapid Acceleration of Diagnostics initiative, or RADx, created in the early weeks of the COVID-19 pandemic to address the need for scaled-up testing across the country. A component targeting underserved populations known as RADx-UP funds community-engaged projects, including CAIRHE’s, that partner with vulnerable communities hardest hit by the pandemic. The CAIRHE project is one of 70 RADx-UP grants nationwide and the only one in Montana.