Safely returning underserved youth to school during the coronavirus disease 2019 (COVID-19) pandemic through diagnostic testing and health education is imperative to mitigate the ongoing negative impact of COVID-19 and reduce health inequalities in underserved communities. The Rapid Acceleration of Diagnostics-Underserved Populations program is a consortium of research projects across the United States funded by the National Institutes of Health to understand the factors associated with the disproportionate burden of the pandemic among underserved populations and to leverage mitigation strategies, including diagnostic testing, with a focus on reducing health disparities. In this article, we provide an overview and introduce the articles from 8 Rapid Acceleration of Diagnostics-Underserved Populations projects featured in the supplement “Navigating a Pandemic in the K–12 Setting: Keeping Our School Communities Safe” published in Pediatrics. These projects funded in the program’s first phase focus on COVID-19 diagnostic testing approaches for youth and employees at schools in underserved communities to support safe in-person learning. In the articles comprising the supplement, researchers present barriers and facilitators of the community engagement process necessary to establish school-academic partnerships. These efforts showcase school-based implementation testing strategies during the COVID-19 pandemic but are translatable to tackling other challenges related to reducing health disparities.
The coronavirus disease 2019 (COVID-19) pandemic has resulted in a staggering reduction in overall life expectancy and widening health and education disparities that will have a profound impact for generations.1 In the United States, >4 million people have been infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and >400 000 have died, with infections and deaths disproportionally affecting underserved populations that have been historically marginalized.2–4 School closures and the early and prolonged switch to remote learning in the United States resulted in unequal access to on-site learning, opportunities to engage in in-person instruction, group interactions, physical activity, and adult supervision and mentorship for underserved youth. Associated learning losses, mental health disruptions, and school dropout rates have been higher in youth from diverse racial and ethnic backgrounds and from low-income homes.1,5 Yet, nationwide, many school districts report that families of color have a reduced preference for sending their children back to in-person learning,6–8 driven by COVID-19 infection concerns and not only on an individual basis. As a result, fewer schools that serve these communities have been open for in-person learning during the 2020–2021 school year. The safe return to schools of underserved youth through screening and health education are imperative to mitigate the ongoing negative impact of COVID-19 and promote health equity for underserved populations.
The Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) program is a consortium of research projects across the United States funded by the National Institutes of Health (NIH) to understand the factors associated with the disproportionate burden of the COVID-19 pandemic among underserved populations and to leverage mitigation strategies, including diagnostic testing, with a focus on reducing health disparities. Addressing health equity relating to COVID-19 disparities is a primary driver of RADx-UP. Partnership with the community using science education and community engagement practices has enabled RADx-UP projects to rapidly implement diagnostic testing in underserved populations. By working together with communities and within settings most affected by the COVID-19 pandemic, RADx-UP projects were able to understand and overcome barriers to SARS-CoV-2 testing across the nation in communities hardest hit by the pandemic. Central to this effort has been ensuring that community partners play an active role in promoting access to high-quality and low-cost testing. Within RADx-UP, 16 projects (8 of 16 funded in the program’s first phase) focus on COVID-19 diagnostic testing approaches for youth and employees at schools in underserved communities to support safe in-person learning (Table 1).
Safe Return-to-School Diagnostic Testing Initiative Projects Within the NIH RADx-UP Program
| Project Title . | Institutions . | Community Partners . | Project Overview . |
|---|---|---|---|
| First Cycle R2S Awardees | |||
| COVID-19 Surveillance and Exposure in School Communities | Duke University | Local and regional North Carolina public schools | This study is structured as a public health initiative in which testing consent is obtained by schools and will combine data received from the schools with data collected directly from students and staff enrolled in the optional school-based testing program to guide analysis of the coprimary objectives. |
| Assessing Testing Strategies for Safe Return to K-12 Schools in an Underserved Population (Safe Return to Schools) | Washington University in St Louis | The St Louis area school districts, CareSTL, Betty Jean Kerr People’s Health Centers, Better Family Life, Beyond Housing | The primary goal of this study is to provide data to inform the utility of screening testing in schools to help in the prevention of COVID-19 transmission. They will compare the effectiveness and acceptance of 2 different school-based testing strategies among students and school staff (symptomatic testing only versus weekly surveillance testing plus symptomatic testing), measuring school-based SARS-CoV-2 transmission through a cluster randomized trial. |
| COV-IDD: Testing for COVID-19 in children at high risk with intellectual and developmental disabilities | University of Rochester | Mary Cariola Center, Community Advisory Board | This project will use a virological and serological testing strategy that addresses multiple health domains to stand up, refine and understand the best strategies for returning this vulnerable population safely to school. |
| ReSET: Restarting Safe Education and Testing for Children with Medical Complexity–SARS-CoV-2 testing in school with children and staff | University of Wisconsin-Madison | Weisman Early Childhood Program | This project aims to increase the safe return-to-school for CMC with a substudy to evaluate the same factors in home-based testing strategies in CMC exclusively. |
| Project SafeSchools | Johns Hopkins University | White Mountain Apache Tribe and Navajo Nation, Community Advisory Board | This project will employ a convergent mixed-methods design, collecting observational, longitudinal quantitative data with embedded qualitative inquiry. Researchers will measure change over time in social, emotional, mental, and physical health as schools reopen and students return to in-person learning. |
| NIH RADxUP COVID-19 Testing, Learning, and Consultation (School TLC) Study | ICF and Children’s Mercy Hospital | Kansas City Public Schools, Community Advisory Board | ICF and Children’s Mercy Hospital are partnering to address barriers to COVID-19 testing and returning to in-person school among vulnerable populations in disadvantaged schools. The project includes 3 sequential phases, each with separate research aims. |
| Using COVID-19 Testing and Risk Communication Strategies to Accelerate Students’ Return-to-School | University of Washington | School districts in the Yakima Valley, Community Advisory Board | Using qualitative interviews with children and adults and focus groups with adults, researchers of this cluster randomized control trial compares the collection of nasal swabs for SARS-CoV-2 testing from children and adults with risk communication to no intervention. Observational data are collected. |
| Supporting the health and well-being of children with intellectual and developmental disability during COVID-19 pandemic | Kennedy Krieger Institute | University Centers for Excellence in Developmental Disabilities, Washington University in St Louis | The primary goal of this study is to enable the successful implementation of saliva-based SARS-CoV-2 testing for children with IDD and school staff so that schools can operate as safely as possible. |
| Second Cycle R2S Awardees | |||
| SCALE-UP Counts: A health information technology approach to increasing COVID-19 testing in elementary and middle schools serving disadvantaged communities | University of Utah | Utah Department of Health, University Neighborhood Partners, Local School Districts | This project will address key testing challenges in schools by building on their collaborations with school districts and with UDOH on COVID-19 testing and existing infrastructure. |
| Impact of COVID-19 Testing and Mitigation on Equitable Return-to-School in the Second Largest US School District | University of California, Los Angeles | LA Unified | This study examines how COVID- 19 surveillance testing influences secondary infection and school attendance and if the disparities in these outcomes are associated with student characteristics, including poverty and race and ethnicity and, additionally, how testing influences parent perceptions of safety, decisions to return in-person, and daily attendance. |
| Communities Fighting COVID!: Returning Our Kids Back to School Safely | San Diego State University | Sweetwater Union High School District in South San Diego County, California | This project will assess whether providing free, at-home COVID-19 rapid antigen test kits to middle school students and staff results in participation equivalent to on-site testing. The study will also evaluate whether a family-based testing model (ie, making tests available to family members) enhances participation. The study will assess implementation of study components to identify resources necessary to ensure ongoing high participation in screening testing to inform scale-up to all 11 middle schools in the district. |
| PAAC SARS-CoV-2 Antigen Testing in the Community | University of Hawaii-Manoa | DOH, and Department of Education | This project is looking at behavioral changes and their impact on testing and attitudes toward vaccination. |
| Back to ECE safely with SAGE: Reducing COVID-19 transmission in Hispanic and low-income preschoolers | Arizona State University | Local Preschools, Community Advisory Board | The overarching goal of this study is to determine the acceptability, feasibility, efficacy, and scalability of back-to-ECE testing in young children (3–5 y). |
| Maximizing Child Health and Learning Potential: How to Promote A School Culture of Safety in the Era of COVID-19 | University of Miami | Miami-Dade County Public Schools, DOH, and The Children’s Trust | The goal of this study is to create a culture of safety in schools by developing COVID-19 vaccine education initiatives to increase vaccination confidence, create testing protocols and access to vaccines in schools. |
| Community-Engaged Viral Testing Strategies to Promote Return to In-Person School in Baltimore City Public Schools | Johns Hopkin University | Community Advisory Board, State School Systems | The overall goal of this project is to conduct a needs assessment and communications campaign to identify public health mitigation and communication strategies that facilitate the safe return to in-person learning in 8 underserved school systems in Maryland and to design a communications campaign to address barriers that are identified. |
| Mobile Health-Targeted SARS-CoV-2 Testing and Community Interventions to Maximize Migrant Children's School Attendance During the COVID-19 Pandemic | University of Nebraska-Lincoln | Nebraska Migrant Education Program, Community Advisory Board | To explore factors that hinder and promote SARS-CoV-2 in-home testing among students in the Nebraska Migrant Education Program and their families, as well as determine the feasibility of mHealth screening tools and programs aimed at addressing socioeconomic challenges specific to this population. In addition, our team seeks to determine public aid and community resources that migrant families see as beneficial to their overall health and well-being during COVID-19 and future similar events. |
| Project Title . | Institutions . | Community Partners . | Project Overview . |
|---|---|---|---|
| First Cycle R2S Awardees | |||
| COVID-19 Surveillance and Exposure in School Communities | Duke University | Local and regional North Carolina public schools | This study is structured as a public health initiative in which testing consent is obtained by schools and will combine data received from the schools with data collected directly from students and staff enrolled in the optional school-based testing program to guide analysis of the coprimary objectives. |
| Assessing Testing Strategies for Safe Return to K-12 Schools in an Underserved Population (Safe Return to Schools) | Washington University in St Louis | The St Louis area school districts, CareSTL, Betty Jean Kerr People’s Health Centers, Better Family Life, Beyond Housing | The primary goal of this study is to provide data to inform the utility of screening testing in schools to help in the prevention of COVID-19 transmission. They will compare the effectiveness and acceptance of 2 different school-based testing strategies among students and school staff (symptomatic testing only versus weekly surveillance testing plus symptomatic testing), measuring school-based SARS-CoV-2 transmission through a cluster randomized trial. |
| COV-IDD: Testing for COVID-19 in children at high risk with intellectual and developmental disabilities | University of Rochester | Mary Cariola Center, Community Advisory Board | This project will use a virological and serological testing strategy that addresses multiple health domains to stand up, refine and understand the best strategies for returning this vulnerable population safely to school. |
| ReSET: Restarting Safe Education and Testing for Children with Medical Complexity–SARS-CoV-2 testing in school with children and staff | University of Wisconsin-Madison | Weisman Early Childhood Program | This project aims to increase the safe return-to-school for CMC with a substudy to evaluate the same factors in home-based testing strategies in CMC exclusively. |
| Project SafeSchools | Johns Hopkins University | White Mountain Apache Tribe and Navajo Nation, Community Advisory Board | This project will employ a convergent mixed-methods design, collecting observational, longitudinal quantitative data with embedded qualitative inquiry. Researchers will measure change over time in social, emotional, mental, and physical health as schools reopen and students return to in-person learning. |
| NIH RADxUP COVID-19 Testing, Learning, and Consultation (School TLC) Study | ICF and Children’s Mercy Hospital | Kansas City Public Schools, Community Advisory Board | ICF and Children’s Mercy Hospital are partnering to address barriers to COVID-19 testing and returning to in-person school among vulnerable populations in disadvantaged schools. The project includes 3 sequential phases, each with separate research aims. |
| Using COVID-19 Testing and Risk Communication Strategies to Accelerate Students’ Return-to-School | University of Washington | School districts in the Yakima Valley, Community Advisory Board | Using qualitative interviews with children and adults and focus groups with adults, researchers of this cluster randomized control trial compares the collection of nasal swabs for SARS-CoV-2 testing from children and adults with risk communication to no intervention. Observational data are collected. |
| Supporting the health and well-being of children with intellectual and developmental disability during COVID-19 pandemic | Kennedy Krieger Institute | University Centers for Excellence in Developmental Disabilities, Washington University in St Louis | The primary goal of this study is to enable the successful implementation of saliva-based SARS-CoV-2 testing for children with IDD and school staff so that schools can operate as safely as possible. |
| Second Cycle R2S Awardees | |||
| SCALE-UP Counts: A health information technology approach to increasing COVID-19 testing in elementary and middle schools serving disadvantaged communities | University of Utah | Utah Department of Health, University Neighborhood Partners, Local School Districts | This project will address key testing challenges in schools by building on their collaborations with school districts and with UDOH on COVID-19 testing and existing infrastructure. |
| Impact of COVID-19 Testing and Mitigation on Equitable Return-to-School in the Second Largest US School District | University of California, Los Angeles | LA Unified | This study examines how COVID- 19 surveillance testing influences secondary infection and school attendance and if the disparities in these outcomes are associated with student characteristics, including poverty and race and ethnicity and, additionally, how testing influences parent perceptions of safety, decisions to return in-person, and daily attendance. |
| Communities Fighting COVID!: Returning Our Kids Back to School Safely | San Diego State University | Sweetwater Union High School District in South San Diego County, California | This project will assess whether providing free, at-home COVID-19 rapid antigen test kits to middle school students and staff results in participation equivalent to on-site testing. The study will also evaluate whether a family-based testing model (ie, making tests available to family members) enhances participation. The study will assess implementation of study components to identify resources necessary to ensure ongoing high participation in screening testing to inform scale-up to all 11 middle schools in the district. |
| PAAC SARS-CoV-2 Antigen Testing in the Community | University of Hawaii-Manoa | DOH, and Department of Education | This project is looking at behavioral changes and their impact on testing and attitudes toward vaccination. |
| Back to ECE safely with SAGE: Reducing COVID-19 transmission in Hispanic and low-income preschoolers | Arizona State University | Local Preschools, Community Advisory Board | The overarching goal of this study is to determine the acceptability, feasibility, efficacy, and scalability of back-to-ECE testing in young children (3–5 y). |
| Maximizing Child Health and Learning Potential: How to Promote A School Culture of Safety in the Era of COVID-19 | University of Miami | Miami-Dade County Public Schools, DOH, and The Children’s Trust | The goal of this study is to create a culture of safety in schools by developing COVID-19 vaccine education initiatives to increase vaccination confidence, create testing protocols and access to vaccines in schools. |
| Community-Engaged Viral Testing Strategies to Promote Return to In-Person School in Baltimore City Public Schools | Johns Hopkin University | Community Advisory Board, State School Systems | The overall goal of this project is to conduct a needs assessment and communications campaign to identify public health mitigation and communication strategies that facilitate the safe return to in-person learning in 8 underserved school systems in Maryland and to design a communications campaign to address barriers that are identified. |
| Mobile Health-Targeted SARS-CoV-2 Testing and Community Interventions to Maximize Migrant Children's School Attendance During the COVID-19 Pandemic | University of Nebraska-Lincoln | Nebraska Migrant Education Program, Community Advisory Board | To explore factors that hinder and promote SARS-CoV-2 in-home testing among students in the Nebraska Migrant Education Program and their families, as well as determine the feasibility of mHealth screening tools and programs aimed at addressing socioeconomic challenges specific to this population. In addition, our team seeks to determine public aid and community resources that migrant families see as beneficial to their overall health and well-being during COVID-19 and future similar events. |
CMC, children with medical complexity; DOH, Department of Health; ECE, early childhood education; UDOH, Utah Department of Health; WECP, Weisman Early Childhood Program.
Addressing the safe return of youth to schools during the COVID-19 pandemic is a public health challenge that calls for Public Health 3.0 solutions.9 A tenet of Public Health 3.0 is the cross-collaboration of multiple sectors and the pooling of data and resources to address social, environmental, and economic conditions that affect health and health equity. Within the context of safe return to schools, school stakeholders and other community members serve as partners for research, and both community and research resources are leveraged to address social, environmental, and economic conditions that have magnified health disparities in communities.10 Grounded in this approach is the acknowledgment that social and structural factors are key drivers of health inequalities and that these inequalities cannot be addressed without the wisdom and expertise of community stakeholders. Stakeholders bring deep knowledge of the historical trauma, lived experiences, values, and concerns of the community that underline the health inequities and are necessary to consider when developing solutions. Bidirectional capacity-building, co-learning, resource sharing, and communication between school and academic partners are critical to address issues of the COVID-19 pandemic using the lens of community experience.
We subscribe to this approach, whereby authentic partnership with community school leaders and trusted representatives drive research questions and evidence-based solutions, with the ultimate goal of benefiting the community through sustained programs and policies. In this sense, the RADx-UP program can be a component of Public Health 3.0 whereby RADx-UP Return-to-School research projects in collaboration with school partners closely align with real-world needs, including COVID-19 screening and education, to prevent persistent health inequalities downstream.
This journal supplement represents work from 8 RADx-UP Return-to-School projects (funded in the first cycle) presented in a special issue of Pediatrics. The work addresses partnerships with schools to promote the safe return to school of youth in underserved communities while building research infrastructure to promote health equity. Additionally, these projects strive to promote co-learning with school partners and the communities they serve to drive health disparities–focused research. Collectively, these efforts aim to reduce COVID-19–related disparities among underserved populations by prioritizing school-academic partnerships and health equity as critical in ensuring that schools have access to testing and have the ability to reopen safely for their students and families during the COVID-19 pandemic.
The research discussed in this supplement addresses the following 2 main questions:
How are bidirectional school-academic partnerships built and operationalized during the COVID-19 pandemic to promote collaboration and extend health disparities research?
What are key implementation strategies for accelerating the implementation of diagnostic testing in underserved school-based populations during the global pandemic?
How Are Bidirectional School–Academic Partnerships Built and Operationalized During the COVID-19 Pandemic?
Inequitable risk of COVID-19 infection and unequal access to care have been observed among lower socioeconomic and racial and ethnic minority populations according to higher hospitalization rates, lower recovery rates, and higher mortality rates.11,12 For example, COVID-19 mortality disparities are reported by poverty level (143 vs 83 deaths per 100 000 person years for areas with high versus low poverty), household crowding (124 vs 48 deaths per 100 000 person years for high versus low household crowding), and racial and ethnic segregation (128 vs 26 deaths per 100 000 person years for high versus low racial and ethnic segregation).13 Racial and ethnic minority populations historically face social drivers of health, including unequal access to quality education, occupational opportunities, and health care.14 Additionally, structural racism exacerbates COVID-19 morbidity, such as the overrepresentation of racial and ethnic minorities in the “essential” workforce, racism in health care, and inequitable incarceration rates.15,16 Moreover, reports indicate that 30% of Hispanic adults and 29% of Black adults versus 39% of non-Hispanic White adults report food security during the pandemic. Food insecurity is associated with fewer resources to work from home, hold jobs, and comply with COVID-19 mitigation recommendations.10 Ongoing inequities within US populations have further exacerbated COVID-19 disparities, propagating loss of housing, health insurance, and steady access to food among Black and Hispanic communities. Schools are critical for physical, social, nutritional, and mental health promotion; adult supervision; technology access; and recreation space for youth. Therefore, the reopening of schools is essential for the social and economic functioning of families, particularly in communities heavily impacted by COVID-19.
Community engagement is increasingly being recognized as enhancing research quality and relevance to public health practice.17,18 The benefits of engaging communities have been reported in all stages of research, including the following: (1) identifying important research questions based on firsthand knowledge and insight from the field, (2) designing informed consent processes and research protocols that meet the needs of the community, (3) adapting interventions to be context-relevant, (4) identifying implementation processes to promote intervention feasibility and adoption, and (5) disseminating research results to make information more accessible.19–21 Within this supplement, researchers in several articles describe the process of engaging the school community, building new school-academic partnerships, and leveraging established long-standing school-academic partnerships to institute testing approaches during the COVID-19 pandemic. The researchers focusing on developing new partnerships describe the challenges faced by different programs and their solutions to overcome those challenges.
Zimmerman et al22 present the findings from local school districts partnering with 5 academic medical institutions in 3 states and explore how these partnerships have guided local grassroots movements to inform coordinated national guidance on COVID-19 mitigation in the kindergarten through 12th grade (K–12) setting. The authors also report on the challenges faced and a potential blueprint for future pandemics and overall improvement in child health. Ko et al23 discuss the development of established, long-standing community–academic partnerships as case studies and describe how these partnerships have supported other health priorities in the community by building systems-level partnerships that engaged researchers within the academic institutions. Guided by the Community-Based Participatory Research Conceptual Model, they discuss the 2 case studies within the context of the model’s 4 dimensions (context, group dynamics, intervention and research, and outcomes) and subdimensions embedded into the dimensions. The article reveals the subdimensions that were critical in mobilizing school–academic partners to rapidly respond to the needs of the community during the global pandemic and institute diagnostic testing to support children and employees to safely return to school. Haroz et al24 provide best practices on implementing COVID-19 or infectious disease testing in school settings by describing key barriers to testing implementation and strategies employed by RADx-UP Return-to-School projects to address these barriers. The authors apply the Consolidated Framework for Implementation Research to organize and structure their observations and recommendations and build knowledge based on the field of implementation science and implementation strategies. Sherby et al25 focus on identifying generalizable and scalable approaches to facilitate safe school reopenings for youth with intellectual and developmental disabilities (IDD). The team highlights the heightened risk for contracting COVID-19 and the associated medical complexities for children with IDD. Additionally, the authors describe prevention strategies and surveillance testing models that are currently being implemented to reduce morbidity among this population.
In their article on optimal methods to evaluate and encourage masking within school settings, Moorthy et al26 describe 2 school districts’ approaches to evaluate and encourage masking in schools. The authors also report on secondary transmission and perceived in-school safety and anxiety among teachers in different evaluation models. Given the critical need to minimize the negative impact of missed days of education on child development and academic achievement, Boutzoukas et al27 further showcase a study by the ABC Science Collaborative that sought to determine the impact of an in-school COVID-19 testing program on testing uptake and quarantine duration after in-school exposure. The authors determined that providing access to in-school testing increased uptake of testing and reduced the duration of missed days at school. In a second article by Boutzoukas et al28 , the authors examine data on 1 102 789 students and staff attending in-person instruction in North Carolina and Wisconsin to determine the impact of distancing practices on secondary transmission of SARS-CoV-2 and the degree of sports-associated secondary transmission. The authors found that with universal masking, low rates of secondary transmission occurred in school; however, sports-associated secondary transmission rates were notable. In addition, Boutzoukas et al29 analyzed data from a large K–12 public school district in Nebraska to determine if eliminating quarantine for students with mask-on-mask SARS-CoV-2 exposure was associated with increased secondary transmission in schools. The authors found that eliminating student quarantine after masked exposure to SARS-CoV-2 within school was not associated with secondary transmission and suggest that eliminating unnecessary quarantine may help maximize in-person learning.
Goldman et al30 present findings from a retrospective, multistate review of mode of learning in K–12 that aimed to identify factors associated with COVID-19 transmission rates and in-person, hybrid, and remote learning. The authors found no relationship between mode of learning and community transmission. In a second article by Zimmerman et al,31 the authors describe the ABC Science Collaborative, a school–academic partnership that supports school districts in making decisions to return to in-person education and generates new data to support equitable and safe school reopenings for every student across North Carolina. The team also discusses data sharing practices as part of the ABC Science Collaborative that led to the implementation of in-person school legislation in early 2021 that required in-person school access for every student and supported the full, in-person reopening of 100 of 115 North Carolina public school districts.
What Are Key Strategies for Accelerating Implementation of Diagnostic Testing During the Global COVID-19 Pandemic?
SARS-CoV-2 screening recommendations for youth vary widely across states and countries. Current Centers for Disease Control and Prevention screening guidelines for congregate child care settings include questioning caregivers about a child’s exposure and symptoms to determine the likelihood of SARS-CoV-2 transmission if a child can attend school. These Centers for Disease Control and Prevention screening practices, now mandated by many state governors’ executive orders and subscribed to in other nations,32,33 may be successful in controlling SARS-CoV-2 transmission in school settings.34–36 Because youth experiencing health inequities predominantly attend school and rely on community child care centers, better practices and protocols for mitigating SARS-CoV-2 transmission are needed to promote the safe return to school. Moreover, schools can serve as centralized institutions for disseminating COVID-19 information and providing resources to curb the spread of transmission, particularly for underserved families who may have limited opportunities to receive information from other venues.
To accelerate implementation of diagnostic testing during the global pandemic, Haroz et al24 shared several implementation challenges and offered solutions for addressing these challenges. Specifically, across all projects, the biggest challenges to COVID-19 testing implementation were related to the perceived advantages versus burden of testing among school stakeholders, recruitment and consenting participants, logistic complexities of testing, results reporting, and contact tracing, all during already packed school days. Strategies that were helpful in overcoming these challenges included enhanced communication with all school stakeholders, research and implementation support teams to navigate logistics, collaboration with local public health and medical personnel, consent forms in formats that are culturally and contextually appropriate and accompanied by educational outreach, engaging community champions, revising incentives, assessing for readiness, and identifying and addressing locally specific barriers and facilitators to testing. Also central to these efforts, the authors determined that fostering school–local public health department communication supported both contact tracing efforts to maximize in-person learning opportunities while mitigating risk and ensured that schools understood local pandemic case rates to respond appropriately. In addition, community advisory boards were critical in guiding the school–academic partnerships to represent the community’s voice and guide testing program design and implementation. Further challenges experienced were related to research policies and protocols (eg, receiving timely institutional review board approval), suggesting that although institutions must have processes in place to protect human subjects research, these processes were not always protective during the pandemic because they delayed the execution of critical programs that were needed rapidly. Research coupled with public health practice and cross-sector collaboration efforts may address these concerns. Academic institutions may also want to review their policies and create processes that can protect human subjects research but also fast track the approval process so critical programs are available to communities rapidly.
Conclusion
In the articles comprising this supplement, researchers present barriers and facilitators of the engagement processes necessary to establish school–academic partnerships. These efforts showcase school-based implementation testing programs during the COVID-19 pandemic but are translatable to tackling other challenges related to reducing health disparities. Even in the presence of established, long-term community partnerships, implementing new programs in school settings requires flexibility, authenticity, and ensuring community empowerment that builds capacity to address disparities related to COVID-19 and beyond.
Acknowledgments
The authors acknowledge Brooke Walker, MS, who provided editorial review and submission of the manuscript.
Dr D’Agostino drafted the initial manuscript, conceptualized and designed the study, and reviewed and revised the manuscript; Drs Ko and Haroz and Ms Linde conceptualized and designed the study; Ms Green and Mr Layer coordinated and supervised data collection and revised the manuscript critically for important intellectual content; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Washington University in St Louis: Washington University/Kennedy Krieger Institute study: This study was registered at ClinicalTrials.gov (identifier NCT04565509). University of Rochester: This study was registered at ClinicalTrials.gov (identifier NCT04887129). University of Wisconsin-Madison: This study was registered at ClinicalTrials.gov (NCT04899245 and NCT04895085). University of Washington: This study was registered at Clinical Trials.gov (identifier NCT04859699). Duke University: This study was registered on clinicaltrials.gov (NCT04831866). Washington. University in St Louis: This study was registered at ClinicalTrials.gov (identifier NCT04875520).
FUNDING: This research was funded in part by the Rapid Acceleration of Diagnostics (RADx) Underserved Populations (RADx-UP) (U24 MD016258; National Institutes of Health [NIH] Agreement No.’s 1 OT2 HD107543-01, 1 OT2 HD107544-01, 1 OT2 HD107553-01, 1 OT2 HD107555-01, 1 OT2 HD107556-01, 1 OT2 HD107557-01, 1 OT2 HD107558-01, 1 OT2 HD107559-01); the Trial Innovation Network, which is an innovative collaboration addressing critical roadblocks in clinical research and accelerating the translation of novel interventions into life-saving therapies; and the National Institute of Child Health and Human Development contract (HHSN275201000003I) for the Pediatric Trials Network (principal investigator, Daniel Benjamin). The views and conclusions contained in this document are those of the authors and should not be interpreted as representing the official policies, either expressed or implied, of the NIH. Funded by the National Institutes of Health (NIH).
CONFLICT OF INTEREST DISCLOSURES: Dr Haroz reports funding from the National Institutes of Health (NIH) National Institute of Mental Health (K01MH116335). Dr Ko reports funding from the NIH National Center for Advancing Translational Sciences (UL1TR002319). The authors have no conflicts of interest to disclose.
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