Abstract

A Policy Framework for Community-Based COVID-19 Testing: Lessons from the Radx-up Initiative

Kamaria Kaalund¹, Kamaria Kaalund, BA¹, Andrea Thoumi, MPP, MSc¹, Ethan Phillips², Gretchen Mason, MPH², Gabrielle Harris, PhD, MSN, RN², Gabriel Carrillo, BS, MS³, Michael Cohen-Wolkowiez, MD, PhD⁴, Warren Kibbe, PhD, FACMI⁵, Giselle Corbie, MD, MSc² (1)Duke-Margolis Center for Health Policy, (2)UNC Center for Health Equity Research, (3)Duke University School of Medicine, Duke University School of Law, (4)Duke Clinical Research Institute, Duke University School of Medicine, (5)Duke University School of Medicine

APHA 2022 Annual Meeting and Expo

Background: The COVID-19 pandemic has magnified how structural racism and other structural determinants of health affect the lived experience of the public health emergency on marginalized communities. Systemic exclusion and structural discrimination continue to create inequities in people’s ability to seek health care and sustain engagement with health services.

Objective: We aimed to identify common barriers that inhibited equitable COVID-19 testing and identify the policy solutions that emerged to address them using real-world examples from the Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) Initiative.

Methods: We conducted an environmental scan of the literature to identify key strategies to reduce disparities in access to COVID-19 testing and highlight how RADx-UP project partners addressed barriers through policy-focused solutions. We used articles identified through the environmental scan, articles identified by the RADx-UP Communications data profile team, meeting minutes in the RADx-UP Dashboard, and prior Duke-Margolis COVID-19 testing and vaccination reports to inform the development of a policy framework for COVID-19 testing that can be applied to other public health interventions. We systematically reviewed 69 Phase 1 (projects initiated before September 1, 2021) project summaries and myRADxUPhome project profiles. We conducted 5 semi-structured interviews with RADx-UP projects to develop case studies.

Results: Five key policy levers for addressing health inequities in COVID-19 and beyond include: access, resource allocation, data, communication and messaging, and payment. Underlying these key strategies are foundational components including authentic community engagement methods, developing cross-sector partnerships, and streamlining regulatory guidance. RADx-UP interventions have focused on increasing access to testing for marginalized populations by: deploying mobile units to expand access, using disadvantage indices to prioritize resource redistribution, embedding community feedback into data collection, collaborating with community leaders to create key messages, and expanding provider payments to support community-based models.

Conclusions: RADx-UP models have removed barriers that prevent people from accessing testing in a timely manner – a necessary step for ongoing pandemic preparedness and accessible testing efforts. The framework proposed offers actionable solutions to support and finance community-based strategies, which have the greatest potential to sustainably reduce health disparities and bridge health equity gaps today and in the future.

Public Health Implications: Community-based models that have promoted COVID-19 testing can be adapted more broadly to ensure individuals have access to health care resources they trust and understand. Health leaders can adapt community-engaged policy strategies piloted during the pandemic to inform ongoing efforts to improve pandemic preparedness and build public health infrastructure.