Overcoming Challenges to Voluntary COVID-19 Testing and Screening in Alabama K-12 Schools.

In response to the COVID-19 pandemic, the US government funded voluntary school-based testing to support safe, in-person learning. In Alabama, this effort led to over 925 000 tests across 814 schools. This Practice Brief Report outlines implementation challenges and adaptive strategies used by the Alabama COVID-19 Testing and Prevention program, led by School of Public Health faculty and staff at the University of Alabama at Birmingham School of Public Health. Key informant interviews revealed 4 main challenges: lack of buy-in, limited capacity, unclear program scope, and short lead time. The team responded by building relationships, offering incentives, engaging School Liaisons, hiring adaptable staff, and ensuring strong leadership. These efforts built trust, increased participation, and reduced staff burden. Findings highlight the importance of local engagement, flexibility, and trust-building in public health work. Lessons learned offer guidance for future school-public health partnerships, especially in politically conservative and resource-limited settings.