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.

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.