# Determinants and Outcomes of Nicotine Metabolite Ratio in HIV + Smokers

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2021 · $1,446,525

## Abstract

Project Summary
 COVID-19, the disease caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), has
led to a global pandemic and has exacerbated existing health inequities among vulnerable populations.
Despite higher rates of COVID-19 in Black and Latinx individuals compared to White individuals, rates of
testing in predominately non-White, low-income communities are significantly lower than in high-income areas.
Strategies to increase COVID-19 testing rates in underserved populations are thus urgently needed.
 Self-testing, where individuals collect their own samples, is now feasible for the detection of SARS-CoV-2.
Self-testing can increase testing convenience and privacy and has been effectively leveraged to expand testing
for other infections, such as HIV, in key populations across a broad spectrum of contexts. However, self-testing
may be limited to those with access to health services, without reaching individuals underserved by existing
medical systems. One promising approach to increase test uptake is the secondary distribution of self-testing
kits, where an individual distributes tests to contacts in their social network and encourages them to self-test. A
significant advantage of a secondary distribution strategy is that by decentralizing a health care process,
individuals may be more likely to access services if delivered by social network peers, rather than health
professionals. In addition, secondary distribution can enhance contact tracing efforts, as individuals diagnosed
with COVID-19 can distribute self-tests to close contacts to identify additional cases. Given high levels of
COVID-19 misinformation, stigma, and medical mistrust among vulnerable populations, this peer-driven test
distribution strategy holds significant promise in increasing the reach of COVID-19 testing among underserved
populations.
 In collaboration with our community-based partner, Public Health Management Corporation, we will
conduct a 1:1 randomized trial with 1048 individuals cared for at Federally Qualified Health Centers to evaluate
whether secondary distribution of SARS-CoV-2 self-tests increases test uptake compared with referrals among
underserved populations in Philadelphia (Aim 1). We will also assess whether the secondary distribution of
self-tests to close contacts among individuals with COVID-19 facilitates case detection (Aim 2). Additionally,
we will use a mixed methods strategy to identify key social, ethical, economic, and behavioral barriers and
facilitators to secondary distribution to inform its future modifications, implementation, and scale-up (Aim 3).
We will engage our relationship with community partners to reach underserved individuals with housing
instability, immigrants, and those with significant medical comorbidities including HIV, viral hepatitis, and
substance use disorders, in order to increase COVID-19 test uptake in these populations. As more rapid and
user-friendly diagnostic tests emerge, this secondary dist...

## Key facts

- **NIH application ID:** 10254935
- **Project number:** 3R01HL151292-01S1
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** ROBERT GROSS
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $1,446,525
- **Award type:** 3
- **Project period:** 2020-11-15 → 2024-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10254935

## Citation

> US National Institutes of Health, RePORTER application 10254935, Determinants and Outcomes of Nicotine Metabolite Ratio in HIV + Smokers (3R01HL151292-01S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10254935. Licensed CC0.

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