Meet Communities Where They Are: COVID-19 Testing for Vulnerable Populations

A recent federal report on COVID-19 infections and deaths by race showed that Black and Latinx populations in the US are three times more likely to contract COVID-19 and nearly twice as likely to die from it as compared with whites. Strategic partnerships and innovative approaches are necessary to reverse these trends. Network for Regional Healthcare Improvement (NRHI) and NRHI research partner and member, Qualidigm, are working with leaders of off-site COVID-19 testing centers (OSCTCs) to identify and share which partnerships and innovations have worked so far.

Reaching and testing vulnerable population groups is a central topic that the participants in the Off-site COVID-19 Testing Project are raising as a core component of their approaches. Considerations on how to engage vulnerable populations when setting up and running an OSCTCs are summarized below.

Reaching Out to Vulnerable Populations

Using Data to Guide Prioritization

Utilizing a combination of data sources, including hospitalization and death rates data, the American Community Survey, social vulnerability indexes, and geospatially based information helped the OSCTCs decide where to set up their sites. This data-driven approach leverages information about major social determinants of health (access to transportation, housing conditions, etc.) as well as an understanding of the communities and where needs are greatest when setting up a testing site. “Sure enough one [site] is in the middle of where 40% of our cases are showing up,” concluded a respondent.

Identifying Partnerships

1. National Guard

Previous discussion on OSCTC partnerships uncovered the significance of working with the National Guard — not only in setting up a test center but also running it. The National Guard was called an “absolute lifesaver” to get things done efficiently and effectively based on what is available. One respondent described their role in making their site “quite tight,” cutting wait time to an average of fifteen minutes.

However, when it came to testing vulnerable populations, the value of this relationship changed – the Guard would be perceived as an obstacle to testing in communities, which not only did not trust but feared people in military uniforms. For example, in one community, a member commented, “it broke that the governor is sending Army people in uniform to predominantly African American public housing structures to test them, so you can imagine the challenge that arose, right?” To counter this, the OSCTC leader increased the presence of civilian testers at the National Guard sites.

2. Social Justice Groups and Community Organizations

For our respondents, building trusting relationships with the communities they were testing was of a critical importance. They wanted to test as many people as possible and be able to do further contact tracing of anyone who tested positive.

Social justice groups and community health workers were the identified partners that had already built strong relationships and earned trust with vulnerable communities. As one respondent put it, “Use local health clinics, and other associations like the National Association of Community Health Centers to help you get the word out and create awareness among those underserved populations. The thing is there are local community organizers, local associations that spend a lot of time on a regular basis thinking about how to communicate to those populations. I think that an important piece is identifying those partners that can help you get the word out [on the importance of COVID-19 testing].”

Education went both ways. For one respondent, this partnership helped them learn what they were doing wrong in communicating with the local Latinx population and what they had to improve in their OSCTC. One of the important things they learned was that “…a lot of folks in our Latinx community don’t go to our county website and they don’t listen to our local radio station. They have their own networks and things that they listen to,” and the OSCTCs had to utilize communication channels that the communities were accessing. This was not the only barrier that OSCTC leaders brought up: “all kinds of cultural barriers, not only language, but the belief that they are immune to the infection…. and fear getting tested because they will get locked up for 14 days and they can’t work, and they can’t feed their kids…so lots and lots of barriers in the testing rates are pretty low right now in those communities, even while the infection rates are high.”

Providing Access within Communities

In addition to cultural, economic, and language barriers, lack of transportation to an established COVID-19 testing site has been perceived as one of the major reasons members of underserved communities do not get tested as much as the general population. To overcome the barrier presented by lack of transportation, many OSCTCs developed innovative approaches to reach out to areas with vulnerable populations.

1. Community pop-ups

Community “pop-up” sites are set up temporarily with the goal of testing specific clusters or a community. One respondent explained “…we have set up purposefully several community-based testing sites that are point-of-care testing sites in underserved communities where the prevalence rates of been quite high, and these are more inner-city locations that don’t necessarily have easy access to testing. Where people don’t have to have a car, they can come by public transportation to get tested…”

These “pop-up” testing sites can rotate locations to broaden access across a region. In one community, each town within the region was visited consistently on a specific day, which eased logistics and staffing, and helped community members keep track of testing schedules. Unfortunately, we also heard that not every community welcomed an OSCTC (temporary or not) and some of them directly said they did not want “COVID in their backyard.”

2. Mobile testing sites

Mobile testing is becoming more common as it offers flexibility and ease to change locations and reach vulnerable population in different settings – from housing projects in the inner cities and homeless shelters to long-term care facilities, correctional facilities, and meat-processing plants.

Mobile testing sites often use vans that are either purchased for the task, or re-purposed from prior uses. Some vans offer point-of-care rapid testing, which provides real-time results for potential clusters. These vans help with making informed decisions about contact tracing and patient quarantines.

Meet Your Community Where They Are

Some partnerships and strategies help speed up the testing process and reach to diverse populations, while others help with building rapport with the communities the OSCTCs are trying to reach. When it comes to testing vulnerable populations, the idea of meeting the community where they are is not only about going to where they are located, but also about creating the means to build trust and inform them about the importance of testing in a way that they will understand. As one respondent said, “we are seeing a lot of environmental anxiety now.” A lack of cultural understanding, language barriers, economic disparities, and legal concerns all contribute to why “the most medically vulnerable” population are not COVID-19 tested. Raising awareness both among OSCTC staff about these barriers and among vulnerable population groups about the importance of testing in a way that is accessible to them is a key to continuing tracking positive cases of COVID-19. Additionally, including community members in development of solutions is of critical importance for engagement and sustainability.

Beyond COVID-19 Testing: Exploring a Broader Role for the OSCTCs

One of our respondents commented that “one of the biggest challenges is communitywide apathy. How do you get the population to re-engage around COVID testing and helping them understand it is not just one-time testing; that repeated testing and communitywide surveillance is a big component of why ongoing testing is needed?” A solution their OSCTC sought was adding the “wrap-around” health and social services such as screening for other diseases, setting up telehealth visits, and helping with registration for state medical programs. Introducing hope in such a dire situation, the respondent offered the vision that the testing sites that can easily reach vulnerable populations will be able to grow “much beyond the scope of COVID testing… we see this as really important to build up the resiliency of the community, not just by virtue of COVID testing, but by addressing all the fundamental other issues that really contribute to adverse outcomes.”

To learn more about COVID-19 testing for vulnerable population, watch the NRHI  webinar Innovative Approaches to COVID-19 Testing for Vulnerable Populations


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