COVID-19 TESTING: COMMUNITY ENGAGEMENT

REMOVING BARRIERS TO ENSURE EQUITABLE ACCESS

RADx-UP COVID-19 Equity Evidence Academy February 25, 2021

Georges C. Benjamin, MD, MACP, FACEP(E), FNAPA Executive Director

SARS-CoV-2

“A collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings”

W.K. Kellogg Foundation (2001)

Community-based Participatory Research (CBPR)

Community Engagement: A Continuum

DHHS. Principles of community-engagement. 2nd Ed. 2011.

• Exposure- Public facing occupations

- Delayed sheltering in place

• Susceptibility- Prevalence of chronic disease

• Social determinates- Lack of paid sick leave

- Transportation

- Poverty

- Housing situation

Societal Determinants Drive COVID-19 Inequities

• Structural

• Behavioral

• Occupational

• Quality of test

COVID-19 Testing and Tracing Inequities Exist As Well

Structural Problems:

COVID-19 Testing

Location & mode of test facility• Location not located in minority communities

• Drive through vs. walk up

• Long lines

• Hours

• Accessibility barriers

Messaging on the need for a gateway providerCall your doctor or health care provider

Cost of testing (Federal coverage for now)

Cost for care (Uninsured or underinsured)

ACCESS TO TESTING

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Behavioral Barriers to COVID-19 Testing

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• Lack of clear understanding of

benefits of test or what results

mean

• Fear of stigma: Black disease

• Fear of discovery

• Lack of trust in “system”

Occupational Barriers

to COVID-19 Testing

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• Unable to take time off from work

• Lack of paid sick leave• Workman’s comp concerns

Type & Quality of Test Available

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• Quality of test available

• Significant number of

tests have:• False positive or false

negative rates

• Not confirmatory

• Test must be reliable &

explainable

Testing & Contact Tracing Linked

• These are linked not separate actions• Core infectious disease prevention, control & heath

protection tool• Provides individual and population-based protection• Lays groundwork for medical care and vaccinations• Requires community engagement for success

Contract Tracing Equity Issues

• Ability to find individuals - Mistrust in contact tracing / Mis-disinformation - Culturally competent interaction- Confidentiality concerns- Don’t know community- Phone access & other contact issues

• Tracers not linked to existing health department Infrastructure• Inability to isolate or quarantine• Poor access to health care• Social determinants that impact finding individuals in 2-3 days

The Research Plan Must BeThe Start of A Relationship

• Community is the center of engagement & unit of identity• Equitable partnership in all phases of research• Build on strengths and resources of community• Fosters co-learning and capacity building• Balance knowledge generation and community benefit• Solve COVID testing & other problems of local relevance • Results available to all partners & involves all partners in wider

dissemination • Not be “one off” engagement. This must be a long-term process

and commitment to sustainability

ENGAGE EARLY

Recommendations

• Upfront

• Throughout the

response

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BUILD TRUST

• Communicate well

• Address

misinformation

• Use trusted

messengers

• Contact tracing by

skilled people

ACCESS TO SERVICES

• Health care access

• Isolation & quarantine support

• Site testing for ease of access

• Transportation services

• Address unanticipated costs

ASSURE CONFIDENTIALITY• Data

• Personal information

INFORM & EDUCATECulturally competent health education

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