A community network-driven COVID-19 testing and vaccination intervention for vulnerable populations in the Central United States: results from a Rapid Acceleration of Diagnostics Underserved Populations randomized controlled trial

Abstract

Background: Community Network-Driven COVID-19 Testing and Vaccination of Vulnerable Populations in the Central United States (C3) evaluates the use of Social Network Strategy (SNS) with educational messaging to improve COVID-19 testing and vaccination among people most impacted by the pandemic.

Methods: We enrolled individuals with low-income who identify as Hispanic/Latino or a history of criminal legal involvement (CLI) through social network referral and randomized participants 1:1 to SNS vs. SNS plus messaging (SNS+), which included a self-affirmation activity and educational video. We assessed for COVID-19 testing and, among baseline unvaccinated participants, vaccination at 21 days, and used mixed effects logistic regression to examine outcomes.

Results: Of 1328 participants (SNS+: 667, SNS: 661), 46.6% identified as Black/African American, 33.4% as Hispanic/Latino, and 43.8% reported history of CLI. Majority (66.3%) reported testing and, of unvaccinated participants, 11.9% reported vaccination at follow-up. There were no differences in testing (aOR 0.89, 95% CI 0.71, 1.11, P = .49) or vaccination (aOR 1.46, 95% CI 0.78, 2.76, P = .30) among participants who received SNS+ compared to SNS after adjusting for recruitment wave and clustering within sites and referral chains.

Conclusions: Social network referral successfully engaged communities disproportionately impacted by COVID-19 in testing and vaccination. Compared to SNS alone, adding educational messaging did not increase testing or vaccination. Additional work is needed to implement SNS to increase vaccination rates among vulnerable populations.

Keywords: Black/African American; COVID-19 testing; COVID-19 vaccines; Hispanic/Latino; criminal legal involvement; social network strategy.