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Although SCALE-UP II and SCALE-UP Counts are starting when COVID-19 appears to be ebbing––with the number of confirmed cases and hospitalizations declining in the state––the researchers say continued testing for the disease is vital, particularly among these at-risk communities.

"Testing is still important because we want people to be able to be with their families and live in their communities safely," says Yelena Wu, PhD, a Huntsman Cancer Institute researcher leading SCALE-UP Counts and an associate professor of dermatology at U of U Health. "From a COVID standpoint, testing is the only way of knowing that you are truly safe."

Testing is also an early warning system that can alert health care providers if COVID-19 cases are on the rise again, says Wu, who is also an investigator at the Huntsman Cancer Institute.

SCALE-UP II builds on SCALE-UP Utah, an initiative begun in 2020 that aimed to increase the acceptance, reach, uptake, and sustainability of COVID-19 screening and testing among underserved groups.

The new initiative, supported by a $2.3 million NIH grant, will target the same population, and utilize many of the same outreach techniques as SCALE-UP Utah. However, it will also use a chatbot to identify hesitancy or other barriers to testing and provide tailored information to address individual needs. A chatbot is software that simulates human-like conversation with users over text.

SCALE-UP II will add other approaches such as mailing in-home testing kits to participants and providing phone calls from community health workers to help address hesitancy and accessibility problems among participants.

The effort will be carried out in partnership with 11 community health systems across the state that operate 38 primary care clinics serving more than 112,000 patients––most of whom live in rural and underserved communities. It is led by Guilherme Del Fiol, MD, PhD, of U of U Health and , of U of U Health and Huntsman Cancer Institute.

SCALE-UP Counts focuses on helping schools in Utah manage and prevent transmission of COVID-19 among students, staff, and families. Volunteers receive a text message letting them know about at-home tests available at their school. Some within each school receive ongoing text messaging that instructs them how to test if they have symptoms or have been exposed to SARS-CoV-2, the virus that causes COVID-19. If necessary, follow-up phone calls are made.

The initiative, supported by a $2.4 million NIH grant, is currently deployed in six schools in the Granite School District, the third-largest in the state with more than 60,000 students. The researchers plan to have SCALE-UP Counts available in at least five more schools at the start of the next school year.

Ultimately, the goal is to identify individuals who test positive so they can isolate themselves and prevent further spread of the virus. If that happens, Wu says, more children and staff can stay in school and school can hopefully remain open.

SCALE-UP II and SCALE-UP Counts both take advantage of pre-existing, evidence-based interventions developed by the team at the (HOPE), led by Wetter at Huntsman Cancer Institute and the Center for Clinical and Transitional Science at U of U Health.