Increasing Representation of Black Communities in COVID-19 Home Testing and Surveillance Data

Background: Black communities experienced disproportionate COVID-19 illnesses and death. Testing shifted from clinic-based PCR to rapid home antigen tests, but little was known about the knowledge, attitudes, and behaviors related to home testing among Black people. This study aimed to understand the willingness to use home tests and to mail self-collected samples for confirmatory PCR testing in Black communities. The study also aimed to understand motivations, barriers, and general knowledge and attitudes about home testing.

Materials/Methods: This was a pre-post intervention study conducted in Black communities in Atlanta, Georgia. Participants received culturally competent oral and illustrated communication messages that encouraged continued COVID-19 vigilance, use of rapid home tests, and self-collection of anterior nares samples for mail-off confirmatory PCR testing. Messages were packaged with a home test kit. Participants were asked to complete a rapid home test and mail the second specimen to a commercial laboratory. The study also included in-depth interviews with a subset of participants who completed the home test and those who did not.

Outcome/Impact: This study assessed knowledge, attitudes, and behaviors related to COVID-19 home testing in Black communities, and willingness, motivations, and barriers to self-collect and mail specimens for confirmatory testing. Findings supported improved communication strategies and provided insight into the feasibility of pairing home testing with mailed confirmatory samples to strengthen public health surveillance in communities with high COVID-19 risk.