Community-based Testing and Primary Care to Mitigate COVID-19 Transmission (2020-2021)

Background COVID-19 has exposed a need for rapid, accessible testing and clinical assessment in the most vulnerable groups, along with a need for effective care management that reaches communities in the longer term. In Durham County, Black and Latinx communities bear disproportionate rates of COVID-19 morbidity and mortality. As of June 2020, Latinx individuals from Duke University Health System (DUHS) were 13 times more likely to test positive for COVID-19 than non-Hispanic white individuals but were 20% less likely to be tested relative to their proportion of the population. COVID-19 services have largely been implemented within existing health service infrastructure and networks that exclude Black and Latinx communities, an approach that has predictably led to the current disparities and resulting inability to mitigate the pandemic in the U.S. Without new, community-based models of care delivery, this problem will continue to worsen. Project Description This project team will address COVID-19 inequities in Durham County by strengthening collaboration between clinical, policy and community partners and assessing long-term sustainability. The roots of health disparities are complex and include underlying structural racism and various socioeconomic factors. To address these issues, the team will: Implement a community-based mobile testing program (Mobile Testing Team) for COVID-19 in Durham County: Team members will work closely with community partners to illuminate the historical contexts of health disparities in order to ensure that services are culturally sensitive. Team members will then investigate the process and lessons of the pilot program. By offering information and enrollment to patients at community sites, team members will increase equity in COVID-19 research studies. Investigate care delivery models for strengthening primary care and community-based care: Team members will assess the scalability of the pilot program to provide community-based clinical services in partnership with community organizations. Through this assessment, the team will identify culturally appropriate, community-based care efforts that meet the specific health needs of the community. Team members will develop case studies and disseminate results of the pilot program to key stakeholders and agencies involved in COVID-19 response. This team's research will inform care delivery redesign efforts and policy discussions in North Carolina concerning health disparities within underserved communities. Anticipated Outputs Mobile Testing Team pilot program; manuscripts; publications; case studies of delivery models; policy brief