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Background: Latine populations in the United States continue to be disproportionately affected by COVID-19 with high rates of infection and mortality. Our community-based participatory research partnership examined factors associated with COVID-19 testing and vaccination within a particularly hidden, underserved, and vulnerable population: Spanish-speaking Latines. Methods: In 2023, native Spanish-speaking Latine interviewers conducted phone-based structured individual assessments with 180 Spanish-speaking, predominantly immigrant Latines across North Carolina. We used univariate and multivariable logistic regression analyses to examine associations between participant characteristics and COVID-19 testing and vaccination. Results: Participant mean age was 41.7 (SD = 13), and 77.2% of the sample reported being cisgender women. Most participants reported immigrating from Latin American countries (89.9%), being uninsured (66.1%), and lacking US immigration documentation (51.1%). While most reported ever being COVID-19 tested (83.3%) and ever being vaccinated against COVID-19 (84.4%), only 24% were up to date with vaccination. Nearly half of the sample reported one or more barriers to COVID-19 testing, and over one-quarter reported one or more barriers to COVID-19 vaccination. Higher educational attainment was significantly associated with ever being tested (P =.031). Fewer concerns about the vaccine, including fewer worries about side effects and having more confidence in vaccine effectiveness and safety, was associated with ever being vaccinated (P <.001). Conclusions: Spanish-speaking Latines face barriers to getting tested and vaccinated against COVID-19. Although ever testing and ever vaccination rates were high, being up to date with recommended vaccinations was low. Educational attainment and concerns about the vaccine were associated with COVID-19 testing and vaccination, respectively. Our findings suggest the need for culturally congruent strategies to address the challenges facing Spanish-speaking Latines in the United States. [ABSTRACT FROM AUTHOR]