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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
9
Behavioral Barriers to COVID-19 Testing
10
• 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
11
• Unable to take time off from work
• Lack of paid sick leave• Workman’s comp concerns
Type & Quality of Test Available
12
• 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
16
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
APHA is a global community of public health professionals and the collective voice for the health of the public. APHA is the only organization that combines 140 years of perspective, a broad-based constituency and the ability to influence federal policy to advocate for and improve the public’s health.
● Founded – April 18, 1872
● 501C(3) & Nonpartisan
● Over 50,000 individual & affiliate members
About APHA