Factors Associated with Trust and Likelihood of Participation in Pandemic-Related Clinical Trials Among Blacks in the U.S. Deep South.

Recruitment for clinical trials among Black populations in the U.S. Deep South is challenging due to general distrust of medical research. The COVID-19 pandemic exacerbated this phenomenon at a time when distrust of the medical community was high. This study evaluated the likelihood of participation in a COVID-19 clinical trial among Black residents in urban and rural counties in the State of Alabama. From 3 counties, 296 participants were queried regarding their awareness of COVID-19 clinical trials, likelihood of participating, medical mistrust, experience with racism, and trust in sources of COVID-19 information. Bivariate analyses compared data by county. A multivariate regression model estimated likelihood of participation in a COVID-19 clinical trial. Participants were majority female (76.9%) with 35% likely to participate; however, only 28.4% were aware of research in their area. Participants' trust in sources of COVID-19 information varied significantly by county (p < 0.001) with rural residents least trustful of information from local health clinics and researchers. Urban residents were least trustful of information from pharmaceutical companies. Multivariate analyses identified two significant predictors increasing likelihood of participation: trust in government clinical trial information (p < 0.001), and awareness of clinical trials in participants' areas (p = 0.02); trust in information from pharmaceutical companies, agreement that racial discrimination occurs in doctor's offices, and household income (p < 0.05) decreased likelihood of participation. Trust and racial discrimination remain primary drivers of low Black clinical trial participation. Recruitment approaches for clinical trials on emergent viral infections should be individualized for each population and locale, built around developing and maintaining trust.