We will meet with people and prioritize together the strategies needed.
In the autumn of 2020, as the pandemic exposed the fault lines of American public health, the National Institutes of Health directed five million dollars toward a question both urgent and ancient: why do some communities bear a disproportionate burden of suffering? Researchers at UT Health Houston joined a 32-institution national effort to map the invisible geography of COVID-19 testing gaps across Texas, focusing on the populations — Hispanic, Black, Indigenous, rural, homeless — where the virus was concentrating most lethally. The work was not merely diagnostic; it was a commitment to intervene in real time, meeting communities where they stood rather than where the system assumed they should be.
- Hispanic Texans, representing less than a third of the state's population, were dying from COVID-19 at nearly half the statewide death toll — a disparity that demanded more than acknowledgment.
- Testing deserts stretched across South Texas, Houston, and the rural Northeast, where high positivity rates signaled not containment but invisibility — the virus spreading undetected through communities with nowhere to turn.
- A five-million-dollar NIH grant activated a three-pronged research effort: mapping infection hotspots, analyzing the networks of community institutions, and co-designing interventions directly with residents in the hardest-hit neighborhoods.
- The RADx-UP initiative placed this Texas effort inside a national reckoning, with 32 institutions simultaneously probing why underserved populations were being left behind in the country's testing infrastructure.
- Researchers built in adaptability by design, using real-time data and community feedback to shift strategies as conditions changed — treating public health not as a fixed prescription but as a living conversation.
In the fall of 2020, with no vaccine yet on the horizon, researchers at the University of Texas Health Science Center in Houston received a five-million-dollar NIH grant with a pointed mission: understand why some Texans were being tested for COVID-19 while others were not — and then change it.
The disparities were measurable and severe. Hispanic residents made up roughly 30 percent of Texas's population but accounted for 40 percent of confirmed cases and nearly 48 percent of deaths. African Americans, American Indians, rural communities, and people experiencing homelessness faced similarly grim odds. The virus was not spreading randomly — it was concentrating in the places with the least access to care and the fewest resources to resist it.
Led by David McPherson and Maria Fernandez, the UTHealth team would focus on three regions where infection was climbing fastest: South Texas, the Houston and Harris County area, and Northeast Texas. They partnered with institutions in the Rio Grande Valley and Tyler, and joined the national RADx-UP initiative — Rapid Acceleration of Diagnostics for Underserved Populations — alongside 31 other research centers across the country.
Their approach wove together three threads: mapping where the virus was spreading and where testing was absent, analyzing the community organizations already serving these populations to find leverage points, and working directly with residents to design interventions in real time. Fernandez was clear that community engagement was central, not supplemental — strategies would shift as data arrived and neighborhoods set their own priorities.
The researchers knew the barriers well: medical mistrust, language gaps, transportation burdens, inflexible work schedules, lack of insurance, and testing sites located far from the people who needed them most. What remained to be discovered was which combinations of outreach, education, and partnership could actually move the needle — in the places where the cost of inaction was already being counted in lives.
In the fall of 2020, as COVID-19 was still ravaging the country with no vaccine in sight, researchers at the University of Texas Health Science Center in Houston received word of a five-million-dollar grant from the National Institutes of Health. The money came with a specific mission: figure out why some Texans were getting tested for the virus while others weren't, and then do something about it.
The problem was stark and measurable. Across Texas, Hispanic residents made up just under 30 percent of the population, yet they accounted for 40 percent of confirmed COVID cases and nearly 48 percent of deaths. Similar disparities plagued African Americans, American Indians, rural communities, and people experiencing homelessness. The virus was not spreading evenly. It was concentrating in the places where people had the least access to care, the most underlying health conditions, and the fewest resources to protect themselves.
The research team, led by David McPherson and Maria Fernandez at UTHealth, would focus on three regions of Texas where infection rates were climbing fastest: South Texas, the Houston and Harris County area, and Northeast Texas. They would partner with the University of Texas Rio Grande Valley and the University of Texas Health Science Center at Tyler. The work was part of a larger national initiative called RADx-UP—Rapid Acceleration of Diagnostics for Underserved Populations—which had awarded similar grants to 31 other institutions across the country.
The researchers' approach had three interconnected pieces. First, they would map the landscape: using hospital records and health department data, they would identify where COVID was spreading fastest and where testing was hardest to access. A high positive test rate in a given neighborhood often meant people weren't getting tested at all—the virus was circulating undetected. Second, they would study the web of organizations already serving these communities: hospitals, clinics, community health centers, nonprofits. By understanding how these institutions connected and communicated, researchers could find leverage points to increase testing. Third, and perhaps most important, they would work directly with residents in the hardest-hit neighborhoods to design and test interventions in real time.
Fernandez emphasized that this last piece—community engagement—was not an afterthought. "We will meet with people in the neighborhoods most affected and prioritize together the education and strategies needed for intervention," she said. The team would use what they called "Community Just In Time Interventions," a method that allowed strategies to shift quickly as conditions changed and new data arrived. The goal was not just to get people tested, but to ensure they understood their results, followed up on them, and participated in contact tracing if needed.
Paul McGaha, who led the Northeast Texas portion of the study, noted the particular urgency in his region. "Many do not have access to COVID-19 diagnostic testing and services," he said. As the only health science center in the area, his institution felt the weight of that responsibility. Belinda Reininger, a regional dean at UTHealth's School of Public Health in Brownsville, framed the work as public health practice at its best: understand the problem, then intervene using data to make the smartest decisions possible.
The study would unfold over months, with researchers collecting data, analyzing patterns, and adjusting their approach as they learned what worked. They were not starting from scratch. They knew the barriers: medical mistrust rooted in history, language obstacles, transportation challenges, work schedules that made clinic visits difficult, lack of insurance, and the simple fact that testing sites were often located far from the communities that needed them most. What they needed to discover was which interventions—which combinations of outreach, education, accessibility, and community partnership—could actually move the needle in places where the pandemic was hitting hardest.
Notable Quotes
By quickly identifying those who have COVID-19, we can reduce spread, which is critical for saving the lives of those most affected by the virus.— David McPherson, principal investigator at UTHealth
The long-term goal is to reduce COVID-19-related disparities and improve health and quality of life of underserved populations.— Maria Fernandez, lead co-principal investigator
The Hearth Conversation Another angle on the story
Why does it matter that some neighborhoods have high positive test rates? Doesn't that just mean the virus is spreading there?
It's the opposite. A high positive rate usually means very few people are being tested at all. If you test everyone, your positive rate drops because you're catching mild cases and asymptomatic people. A high positive rate means the virus is circulating invisibly.
So the researchers are trying to find people who don't know they're sick?
Partly that. But also people who know they might be sick but can't get to a testing site, or don't trust the system, or work jobs where taking time off means losing pay. The disparities aren't random.
The numbers about Hispanic Texans are striking—40 percent of cases but 29 percent of the population. Is that because of density, or something else?
It's multiple things layered together. Higher rates of diabetes, asthma, hypertension in underserved communities. Jobs that can't be done from home. Multigenerational housing. Less access to early care. The virus finds the cracks in the system.
What does "Community Just In Time Interventions" actually mean in practice?
It means if data shows a spike in a particular neighborhood on a Tuesday, by Thursday the team can have new flyers, new messaging, maybe a mobile testing unit, tailored to what that community needs right then. It's adaptive, not one-size-fits-all.
Why involve community members in designing the interventions? Why not just tell them what to do?
Because people know their own neighborhoods better than any researcher does. They know where people gather, what languages they speak, what barriers actually exist. And they're more likely to trust and follow strategies they helped create.
What happens after the five years of funding end?
That's the real question. The hope is that the partnerships built and the strategies that work get embedded into the regular health system. But that requires political will and sustained funding.