Community-Based COVID-19 Testing Ensures Protection for All Populations

For Immediate Release: May 10, 2022

Community-Based COVID-19 Testing Ensures Protection for All Populations

A new policy framework details ways to close COVID-19 testing equity gaps

Durham, NC – As the nation surpasses more than one million deaths due to COVID-19—currently, the third leading cause of death in the United States—researchers from Duke-Margolis Center for Health Policy, UNC Center for Health Equity Research, and Duke Clinical Research Institute issued a policy framework with actionable steps for policymakers, providers, and the National Institutes of Health RADx Underserved Populations (RADx-UP) Initiative to facilitate more equitable COVID-19 testing.

The National Institutes of Health (NIH) established the Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) Initiative in April 2020 as part of a broader NIH initiative focused on scaling innovation, development, and commercialization of diagnostic tools to support COVID-19 testing. The initiative is a $512 million investment aiming to test and scale community-engaged projects that seek to reduce disparities in COVID-19 testing access and uptake. To date, RADx-UP includes over 120 projects across 56 states, territories, and the District of Columbia. Lessons learned from RADx-UP provide important implications for policy directions as new COVID-19 variants emerge and efforts to keep all populations protected. As of March 2022, states have a remaining $70 billion in American Rescue Plan Act funding to allocate by 2024 and spend by 2026.

“As health care organizations and policymakers design their longer-term COVID-19 testing strategies, RADx-UP has shown how collaborations with communities can help make testing accessible to everyone,” said Dr. Mark McClellan, Director, Duke-Margolis Center for Health Policy. “Evidence-based steps to protect all populations will help America manage future threats from COVID-19 and other infectious diseases.”

The framework emphasizes that continued COVID-19 mitigation efforts, including testing, are essential to manage further spread of the virus and to keep communities safe, particularly, for historically marginalized populations experiencing the greatest impact of the pandemic. These communities include Black, Latino or Latinx, American Indian, Alaska Native, Asian, Native Hawaiian and Pacific Islanders communities as well as people who are incarcerated, low-income, older adults, children, disabled, LGBTQ+, and birthing people.

“Focusing COVID-19 testing strategies on health equity is paramount to reaching communities that are often left behind” said Dr. Giselle Corbie, Director of UNC Center for Health Equity Research and co-Investigator of RADx-UP CDCC. “We can ensure all populations are protected by implementing community-based COVID-19 testing, along with other public health measures that put equity first.”

The framework, based on RADX-UP research, identifies five key actions to address health inequities in COVID-19 and beyond, based on real-world experience from RADx-UP projects:

1. Extend the reach of existing health care infrastructure to expand access: Efforts to promote access have included creating additional COVID-19 testing sites, such as walk-up testing sites that eliminate the requirement to have a car to be tested, mobile testing sites, and at-home solutions. Other efforts include developing community partnerships and creating multilingual testing sites to ensure cultural and linguistic acceptability.
2. Use novel tools and measures to bolster equitable distribution and resource allocation: RADx-UP projects have utilized geographic information to pinpoint priority testing communities or areas where access to COVID-19 testing centers is limited or not available.
3. Increase data protections and incorporate community feedback when standardizing data collection to address health inequities: These strategies are important for overcoming privacy concerns and language barriers, and addressing technical data challenges when they arise.
4. Develop transparent, community-informed messaging and communication: Strategies include a focus on recruiting community leaders and public figures in health care, government, and public health to communicate information about COVID-19 and how to reduce risk of exposure through safety measures (e.g., social distancing and wearing masks).
5. Develop provider payments that facilitate community-based delivery of testing beyond a traditional clinical setting and reduce cost sharing for populations seeking testing: The most significant policy solution resolving payment challenges was the implementation of free testing at the point-of-care. Additionally, lessons learned from the pandemic demonstrate the need to support payment models that sustainably fund community health worker salaries.

“The RADx-UP evidence shows us ways to close equity gaps in COVID-19 by remediating structural inequities such as barriers to accessing the health system” said Andrea Thoumi, Health Equity Policy Fellow, Duke-Margolis Center for Health Policy and lead author. “Health care partnerships to expand access to community-based testing is an equitable policy solution that can lead to measurable improvements in access and reductions in health disparities.”

“Investing in equity-informed data science can help mitigate continued systemic exclusion, systemic disenfranchisement, and structural racism in healthcare that impact the health of all Americans” said Dr. Warren Kibbe, co-Investigator of RADx-UP CDCC, Duke University.

“Improving data systems to capture evidence on strategies that eliminate access barriers is a critical step to advancing academic-community partnerships” said Dr. Michael Cohen-Wolkowiez, co-Investigator of RADx-UP CDCC, Duke Clinical Research Institute. “These partnerships offer long-lasting solutions and there is a real opportunity to leverage the RADx-UP network to enhance health equity and health disparities research in the future.”

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About the RADx® Underserved Populations Coordination and Data Collection Center (RADx-UP CDCC)

The RADx-UP Coordination and Data Collection Center (CDCC) is the central leadership and support team assisting the NIH and RADx-UP projects across the country as they serve their communities. The CDCC, led by The Duke Clinical Research Institute (DCRI) and UNC Center for Health Equity Research (CHER), oversees the RADx-UP program and its funding awards to more than 125 research teams across the United States and its territories as well as Tribal Nations. The CDCC is organized into four core support teams: the COVID-19 Testing Core; the Community engagement Core, the Data Science and Biostatistics Core; and the Administrative Core. For more information, visit https://radx-up.org/about/coordination-center/ and follow us on Twitter @RadxUp.

About the Duke-Margolis Center for Health Policy

The mission of  the Duke-Margolis Center for Health Policy  is to improve health, health equity, and the value of health care through practical, innovative, and evidence-based policy solutions. For more information, visit healthpolicy.duke.edu and follow us on Twitter @DukeMargolis.

About the UNC Center for Health Equity Research (CHER)

Part of the UNC School of Medicine, CHER brings together collaborative, multidisciplinary teams of stakeholders to improve health in North Carolina communities, with a shared commitment to innovation, collaboration, and health equity. CHER members generate new knowledge and contribute to the science of health equity research and implementations, thus driving innovation in collaboration with communities to improve well-being. For more information, visit med.unc.edu/cher and follow us on Twitter @uncCHER.

About Duke Clinical Research Institute (DCRI)

Part of the Duke University School of Medicine, DCRI is the world’s largest academic clinical research organization. They conduct innovative research to deliver on their mission to share knowledge that improves the care of patients around the world. For more information, visit dcri.org and follow us on Twitter @DCRINews.