Developing a Realtime Monitoring System and Program to Improve COVID-19 Testing for Latinx Populations

Nationally, Latinx individuals have four times the rate of SARS-CoV-2 diagnoses compared to Non-Hispanic Whites. Furthermore, Latinx populations may face barriers in accessing SARS-CoV-2 tests, receiving test results, interpreting test results, and getting appropriate follow-up care. Improved understanding of the sources of health equity differences for Latinx populations can be used to better guide allocation of resources and provide essential data for provider organizations seeking to support those in the most need. Through this RADx-UP project, a statewide research and monitoring infrastructure was established in partnership with community clinics. This study developed community health teams ("Promotoras Teams") with the largest Latinx community organization in Rhode Island to address identified barriers to COVID-19 testing through patient navigation, health literacy support, and follow-up care. The overall goals of this study were to improve testing uptake and the understanding of SARS-CoV-2 outcomes among Latinx populations. This study built on partnerships with community clinics that serve a high proportion of Latinx individuals (>50%) in Rhode Island. This study placed particular emphasis on disparities in care faced by Latinx populations and factors that have been identified as impacting health equity in Rhode Island (integrated healthcare, community resilience, physical environment, socioeconomics, and community trauma). The insights gained from the quantitative and qualitative approaches were used guide the implementation of community campaigns to improve testing among Latinx populations that are in identified locations with lower per capita testing than other parts of the state ("testing deserts"). This RADx-UP project utilized a unique approach and infrastructure to monitor SARS-CoV-2 testing rates, including the use of the statewide Health Information Exchange (HIE) in Rhode Island that connects data across primary care, urgent care, specialty care, and acute care clinical environments. The HIE contains clinical data for most people receiving care in Rhode Island including SARS-CoV-2 test results from major laboratories and other facilities (e.g., CVS MinuteClinic). These quantitative data were combined with qualitative data and organized according to the Consolidated Framework for Implementation Research framework to guide the mixed-methods explanatory sequential design. The specific aims of this project were to: (1) Identify COVID-19 hotspots and testing deserts using a near-real time geographic information system monitoring system; (2) Determine community and provider barriers that impact access to SARS-CoV-2 testing; and, (3) Implement community-based approaches to improve SARS-CoV-2 testing. This RADx-UP project developed a community-based infrastructure to enable structured, longitudinal relationships with a historically underserved patient population. Such insights provide essential data for a population-level decision support system, testing prioritization, and for future consideration of vaccine-based prevention strategies.