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Identifying optimal testing modalities to increase Covid-19 testing access in Baltimore, Maryland
Protocol for a household randomized controlled trial
Duchen, J., Mueller, A. K., Ahmed, S., Perin, J., Borsuk, C., Trowell, J., Lowensen, K., Huettner, S., Peytchev, A., Farley, J. E., Mehta, S. H., & Jennings, J. M. (2025). Identifying optimal testing modalities to increase Covid-19 testing access in Baltimore, Maryland: Protocol for a household randomized controlled trial. JMIR Research Protocols, 14, Article e68600. https://doi.org/10.2196/68600
Background: The COVID-19 pandemic disproportionately affected low-incomeand racial and ethnic minority populations. Testing plays a critical role in disrupting disease transmission, but complex barriers prevent optimal testing access, particularly for Black and Latinx communities. There is limited evidence regarding the optimal testing modalities to increase testing access for these populations. Objective: This study aimed to define the optimal COVID-19 testing modalities for maximizing testing acceptance, uptake, and timeliness of receipt of results. Methods: The Community Collaboration to Combat COVID-19 (C-FORWARD) trial was a household randomized comparative effectiveness trial conducted in a representative sample of an urban population. Households across 653 census block groups were sampled using a probability proportional to size approach. The primary outcome was the completion of SARS-CoV-2 or COVID-19 testing within 30 days of randomization. Results: Between February 2021 and December 2022, a total of 1083 individuals were enrolled, including 881 (81.35%) index participants and 202 (18.65%) household members. The mean age of participants was 51 (SD 18) years.Of the total sample, 43% (n=460) of participants identified as Black or African American, 48.6% (n=526) as White, and 9% (n=91) as other, including Asian, American Indian, Native Hawaiian or Pacific Islander, and multiple races; 4.8% (n=48) of participants identified as Hispanic or Latino. At the time of enrollment, 51.1% (n=553) were currently working either full time or part time, and 32.9% (n=342) of participants had an advanced degree.In total, 80% (n=809) of participants had been tested for COVID-19 previously, with 22.3% (n=179) reporting a prior positive test for COVID-19, and 86.8% (n=890) reporting receiving at least one COVID-19 vaccination before enrollment. Conclusions:Data from the C-FORWARD trial will be used to address important questions regarding COVID-19 testing acceptance and uptake in an urban population. International Registered Report Identifier (IRRID): RR1-10.2196/68600
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