By KAY HAWES
KU Medical Center
The University of Kansas Medical Center has been chosen as one of 32 institutions nationwide to receive a grant from the National Institutes of Health (NIH) through the RADx-UP program to support projects designed to rapidly implement COVID-19 testing strategies in populations disproportionately affected by the pandemic.
KU Medical Center will partner with community efforts in 10 Kansas counties, six rural (Crawford, Finney, Lyon, Riley, Saline and Seward) and four urban (Douglas, Johnson, Sedgwick, Wyandotte).
The goal is to establish community-led, health department-linked Local Health Equity Action Teams in 10 counties in Kansas disproportionately affected by COVID-19 and provide them with the training and resources to identify and respond to COVID-related inequities in their communities.
Address inequities, beginning with testing
"We know that underserved minority and rural communities have been disproportionately affected by COVID, leading to more serious illnesses and more deaths," said Edward Ellerbeck, M.D., MPH, chair of the Department of Population Health and professor at the KU School of Medicine and one of the study's co-principal investigators. "The idea here is to partner with communities and local health departments to help address inequities, beginning with inequities in testing, and the vast majority of these funds will go into these counties and directly into these at-risk communities."
Part of the NIH's Rapid Acceleration of Diagnostics (RADx) initiative, the RADx Underserved Populations (RADx-UP) program, KU Medical Center's $3.5 million grant will be overseen by four principal investigators:
●Mario Castro, M.D., MPH, vice chair for clinical and translational research in the Department of Internal Medicine and a pulmonologist at the KU School of Medicine.
●Broderick Crawford, president of the NBC Community Development Corporation, the outreach arm of the New Bethel Church in Kansas City, Kansas.
●Allen Greiner, M.D., MPH, vice chair of the Department of Family Medicine and professor at the KU School of Medicine, and county health officer in Wyandotte County.
"It is critical that all Americans have access to rapid, accurate diagnostics for COVID-19, especially underserved and vulnerable populations who are bearing the brunt of this disease," said NIH Director Francis S. Collins, M.D., Ph.D. "The RADx-UP program will help us better understand and alleviate the barriers to testing for those most vulnerable and reduce the burden of this disease."
Partner with communities, developing strategies
KU Medical Center researchers will conduct a needs assessment in each county and then partner with communities in each county to develop messages and strategies specific to their community. Working with the Local Health Equity Action Teams, KU researchers will take their cues from the communities. "In some cases, we will support what they're already doing. In some cases, we will complement what they're doing," said Mariana Ramirez, LMSW, director of JUNTOS Center for Advancing Latino Health in the Department of Population Health at KU Medical Center and one of eight co-investigators on the grant. "It is critical that we listen to each community and assist them with what is needed there."
Castro, who also directs the KU Clinical and Translational Science Institute, known as Frontiers, points out that this grant is unique because it relies on partnerships in the community and throughout the state.
"It is an exciting grant for KU Medical Center and for our partners because it will capitalize on the infrastructure we have built with Frontiers and community partners and help all of us work together to address disparities within our underserved communities," Castro said.
"A number of studies have shown that African-American, Hispanic and rural communities have a higher prevalence of hospitalization and deaths, and there is some evidence that the virus also is more severe in these communities, perhaps due to a higher proportion of risk factors, such as obesity and high blood pressure. And when we look at rural counties, we also see overwhelmed practitioners and no infrastructure for conducting clinical trials. With the RADx-UP resources, we think this could really be a win-win relationship with these communities."
Use Wyandotte County task force as model
KU Medical Center has been working throughout the pandemic with Wyandotte County community leaders, and Greiner explained that the statewide effort will be modeled after the work of the Health Equity Task Force in Wyandotte County.
"We've had some really great community partners step up in Wyandotte County," Greiner said. "There's been a lot of collaboration. Throughout the pandemic, we've seen some really tough issues throughout the community. We think our partners can help share lessons learned, and those best practices can be valuable in advising other counties."
While the underserved populations in each county may be different, many of the obstacles are the same:
●Multiple generations may be living in one household.
●Family members may be engaged in high-risk, essential work, perhaps in meatpacking or cleaning industries.
●A lack of health insurance and lack of sick leave may be an issue.
●Another set of issues is lack of access to medical care and lack of COVID-19 testing.
"We saw the first COVID-19 death in Kansas in Wyandotte County, but there was no testing in Wyandotte County at that time," Crawford said. "We determined we needed to take testing into the community."
Crawford noted that pop-up testing sites in churches, libraries and colleges were well attended. "We put pop-up sites in places in the community where the need was greatest and also in places people trusted."
Provide collaborative effort
"With this grant, the idea is to be able to share the successes in Wyandotte County with the nine other counties throughout Kansas," Crawford said. "It won't look the same in each of these counties, but we want to provide information and lessons learned. One thing COVID has shown all of is that there has to be joint collaborative effort by all of us -- researchers, community leaders, faith leaders, doctors, health offices -- to fight this disease."
For more information on the NIH's RADx initiative and RADx-UP program, see the NIH website.