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Across the US, COVID-19 is hitting some communities harder than others, and Utah is no exception. In our state, Latinos make up 14 percent of the population but represent 40 percent of cases. Similarly, there are disproportionately high case and death rates among Pacific Islanders, African-Americans, Native Americans, and Utahns living in low-income neighborhoods.

With a goal of reducing health disparities in Utah, the National Institutes of Health (NIH) has awarded $5 million to Rachel Hess, M.D., and of Ï㽶ÊÓƵ of Utah Health, and , of Huntsman Cancer Institute and U of U Health. The team leads SCALE-UP Utah, an initiative that aims to increase the acceptance, reach, uptake, and long-term sustainability of COVID-19 screening and testing. The initiative will be carried out in partnership with 12 community health center systems across the state that run 39 primary care clinics serving more than 115,000 patients—most of whom live in rural and underserved communities.

"SCALE-UP Utah brings together partners from across Utah to ensure that there is adequate screening and testing for all population groups with a specific emphasis on those experiencing higher rates of COVID-19 infection," Wetter says. "No one should be left behind in being protected from COVID-19."

U of U Health is one of 32 institutions that received an NIH award through the ) initiative. The program supports both projects designed to rapidly implement COVID-19 testing strategies in populations disproportionately affected by the pandemic and research that aims to better understand COVID-19 testing patterns among these populations.

"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," says Francis S. Collins, M.D., Ph.D., director of NIH. "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."

SCALE-UP Utah takes advantage of pre-existing, evidence-based interventions developed by the team at the Center for Health Outcomes and Population Equity (HOPE), led by Wetter at Huntsman Cancer Institute and the Center for Clinical and Translational Science at U of U Health. These include:

• Initiating text messaging dialogues about testing and testing logistics between health care providers and patients who are at high risk for infection or severe disease.
• Designing information technology tools that prompt health care providers to ask, advise, and connect patients to COVID-19 screening and testing.
• Engaging patient navigators to motivate patients and address logistics and barriers that could otherwise prevent them from being tested for COVID-19.

The program is designed to roll out quickly and adapt as needed in order to reduce COVID-19-related health inequities. Wetter says an important goal of SCALE-UP Utah is to serve as a model for other health care systems that serve vulnerable and underserved populations.

Long-standing partnerships between the Center for Clinical and Translational Science, Huntsman Cancer Institute, Association for Utah Community Health, statewide community health centers, and the Utah Department of Health provide additional infrastructure and resources that will improve the reach of COVID-19 screening and testing.

In the future, the program can be readily adjusted and redeployed to meet additional health needs that arise during the pandemic. "SCALE-UP Utah will build an infrastructure that can be used for equitable dissemination of a COVID-19 vaccine once it becomes available," Wetter says.

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