To help reduce the health gaps associated with COVID-19 in vulnerable populations in Texas, a multi-institutional team of researchers led by the University of Texas Houston Health Science Center (UTHealth) will identify disease foci and test deserts in three racially diverse areas, and then develop and evaluate intervention strategies to increase testing on COVID-19.
The study, funded by a $ 5 million National Institutes of Health grant to UTHealth through the Center for Clinical and Translational Sciences (CCTS), will focus on three areas of the state with a high rate of infection – South Texas, Houston / Harris County and Northeast Texas. Research partners include the University of Texas at Rio Grande Valley (UTRGV) and the University of Texas at Tyler Health Center (UTHSCT).
“Finding the reasons for the differences in testing is the first step toward reducing those differences in the vulnerable population,” said David McPherson, MD, chief investigator for CCTS research and chairman of the Department of Internal Medicine at McGovern Medical School at UTHealth. “By quickly identifying those who have COVID-19, we can reduce the spread, which is crucial to saving the lives of those most affected by the virus.”
The study is funded by the Rapid Diagnostic Acceleration Initiative (RADx). As part of the initiative, the RADx Underpopulated Population (RADx-UP) program will support research aimed at better understanding COVID-19 testing patterns among poor and vulnerable populations; strengthen data on differences in infection rates, disease progression and outcomes; and develop strategies to reduce differences in testing on COVID-19.
UTHealth is one of 32 institutions nationwide to receive the 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 / Alaska Natives, Latinos / Latins, Hawaiian Indigenous people, older adults, pregnant women, and those who are homeless or imprisoned.
“It is critical that all Americans have access to rapid, accurate diagnosis for COVID-19, especially the under-supplied and vulnerable population that carries the greatest burden of the disease,” said NIH Director Francis S. Collins, MD, Ph.D. Honey. “The RADx-UP program will help us better understand and alleviate testing barriers for those most at risk and reduce the burden of this disease.”
The study will try to understand why vulnerable populations, such as those with medical comorbidities and people who have homelessness, have significant differences in coronavirus infection rates and mortality. Underupplied populations such as blacks, Latinos, those living in rural areas, and underinsured individuals have higher rates of co-morbid conditions, including diabetes, obesity, asthma, and hypertension, putting them at risk for serious illness. In Texas, Hispanics make up 29.4% of the population, but 40.1% of COVID-19 cases and 47.9% of confirmed deaths, according to the Texas Department of the State Health Service.
“The long-term goal is to reduce the differences associated with COVID-19 and improve the health and quality of life of the underpopulated population,” said Dr. Maria E. Fernandez, lead study lead researcher and distinguished professor Lorne Bain at Public Health and Medicine at UTHealth School of Public Health. “One of the sweetest components of the study is part of the engagement in the community where we will meet people in the most vulnerable neighborhoods and jointly determine the education and strategies needed for the intervention.”
The study has three general objectives:
Identify priority areas based on disease outbreaks, testing approaches, and the prevalence of chronic conditions. Identify and examine relationships between different organizations in these priority service areas. Use the data from the first two objectives to prioritize intervention activities, tailoring and applying materials, methods, and strategies to increase testing.
“We want to not only encourage people to get tested, but to monitor the results and, if necessary, practice behavior to protect themselves and others and participate in seeking contacts,” Fernandez said.
To identify priority areas, researchers will use data from regional health departments and hospital records to assess the availability and use of real-time testing by residents. It will also examine the frequency and test a positive rate. The higher the positivity rate, the more likely the test is low in a particular area.
For the second goal, by looking at relationships among service-providing organizations, researchers hope to maximize system-level performance to increase testing.
Community engagement is an integral part of the study and is used in the third goal to develop, implement, and evaluate a real-time adaptive intervention approach that responds to rapidly changing conditions and the needs of priority communities to increase testing. Researchers will examine whether engagement approaches and resulting interventions increase testing and monitoring of COVID-19.
“The integration of these goals and their interactions is unique and shows how public health can be practiced. We work to understand the problem and then intervene in a way that uses data to make the best decisions,” said Belinda Reininger, DrPh, professor and regional dean of UTHealth School of Public Health in Brownsville. “The areas in which we work are extremely needed due to health inequalities. The proposed study will test strategies to improve access to testing in rural, border and urban populations.”
Fernandez said the team will use “Joint Interventions on Time,” an innovative concept that dynamically identifies priority areas using rapidly changing data so that strategies can be quickly tailored to community needs.
The paper will bring together researchers and community partners for a truly collaborative approach. Co-investigators of the study are Fernandez; Reininger, who is in the Department of Health Promotion and Behavioral Science; and Dr. Marcia C. Otto, assistant professor in the Department of Epidemiology, Human Genetics, and Environmental Sciences at the UTHealth School of Public Health.
The principal investigator for UTRGV is Dr. John M. Thomas III., Assistant Professor in the Department of Biology, Faculty of Science; and for UTHSCT is Paul McGaha, DO, MPH, Chair and Associate Professor in the Department of Community Health Care for the School of Health and Rural Health. Numerous researchers from partner institutions are involved to ensure that a multidisciplinary approach is used to address this complex problem.
“This study will be of great significance to populations that do not have enough space in Northeast Texas,” McGaha said. “Many do not have access to the COVID-19 diagnostic test and services. As the only health center in the area, we want to help our regional communities respond to the coronavirus pandemic.”
The community and health care organizations in Houston participating in the study include physicians from UT, Avenue 360, Homeless Health, the HOPE Clinic, and the Spring Branch Community Health Center. Community partners are the City of Houston, 2-2-1 Texas / United Way of Greater Houston, Harris County Public Health, Greater Houston Partnership, University of Texas, MD Anderson Cancer Center, Department of Health Inequalities, Cameron County Public Health, City of Brownsville, Northeast Texas Public Health District, Pro-Salud, Texas Health Centers Association, and Baker Ripley. Laboratories include UTHealth Pathology and Baylor College of Medicine.