Make the Pasta
Bring a large pot of water to a boil and season it with kosher salt. Cook the ditalini pasta according to the package directions until it is tender but still has a bite to it (al dente). Drain the pasta, drizzle slightly with oil to prevent sticking, and set aside.

Brown the Sausage
Heat a large sauté pan over medium-high heat and add the avocado oil. Once the oil is shimmering, add the mild ground sausage. Break it up with a spoon and sauté until it is golden brown and fully cooked.

Sauté Aromatics
Add the diced sweet onion and minced garlic to the pan with the sausage. Sauté for 2 to 3 minutes until the onion is translucent and fragrant.

Caramelize Tomato Paste
Add the tomato paste to the center of the pan. Allow it to cook and fry in the fat for 2 to 3 minutes, stirring occasionally. This step caramelizes the sugars in the tomato paste, deepening the flavor. Season with a pinch of salt and cracked black pepper.

Deglaze and Reduce
Pour in the low sodium chicken broth to deglaze the pan, using your spoon to scrape up any flavorful browned bits from the bottom. Let the broth simmer until reduced by half, then lower the heat to medium-low.

Make it Creamy
Pour the heavy cream into the pan and stir well to combine, creating a smooth, cohesive sauce.

Add Cheese and Combine
Stir in the grated Parmesan cheese until melted and the sauce becomes velvety. Add the cooked ditalini pasta to the pan and toss until every noodle is well coated in the sauce.

Serve
If the sauce becomes too thick, stir in a small splash of extra broth or water to loosen it. Garnish with red pepper flakes for a little heat and enjoy immediately.