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More than two years after the first COVID-19 cases were reported in Utah, demographically underrepresented populations in the state continue to test positive for the disease at greater rates than other racial or ethnic groups.

As of early April, about 35% of Hispanics, 34% of Native Americans, and 30% of Blacks had tested positive for COVID-19 compared to about 25% of Whites and Asian Americans. Overall, infection rates are 20% to 40% higher among non-Whites. In addition, less than 60% of the state’s Hispanic population is fully vaccinated against the disease, far lower than any other racial or ethnic group.

In their quest to overcome these health disparities, University of Utah Health scientists are launching SCALE-UP II and SCALE-UP Counts, a pair of initiatives designed to increase COVID-19 testing and vaccination among rural and underserved populations. Combined, the two initiatives are supported by $4.7 million from the National Institutes of Health (NIH).

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, the principal investigator involved with 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 of U of U Health and David Wetter 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 Center for Health Outcomes and Population Equity (HOPE), led by Wetter at Huntsman Cancer Institute and the Center for Clinical and Transitional Science at U of U Health.

University of Utah Health  provides leading-edge and compassionate care for a referral area that encompasses 10% of the U.S., including Idaho, Wyoming, Montana and much of Nevada. A hub for health sciences research and education in the region, U of U Health touts a $428 million research enterprise and trains the majority of Utah’s physicians, including more than 1,460 health care providers each year at its Colleges of Health, Nursing and Pharmacy and Schools of Dentistry and Medicine. With more than 20,000 employees, the system includes 11 community clinics and five hospitals. For 12 straight years, U of U Health has ranked among the top 10 U.S. academic medical centers in the rigorous Vizient Quality and Accountability Study.