Rapid Acceleration of Acceptable COVID Testing and Care Options for NYC Public Housing Residents (RADx NYCHA)

Background: The purpose of this study was to improve COVID-19 testing access and uptake among residents of the New York City Housing Authority (NYCHA), a large, predominantly Black and Hispanic public housing population disproportionately affected by COVID-19. NYCHA housed nearly 400,000 residents across developments concentrated in lower-income neighborhoods, where median family income was about $20,000 and barriers to healthcare access were persistent. This study leveraged the infrastructure of an existing NIH-funded project and long-standing partnerships among NYCHA Resident Associations, the NYC Health Department, NYC’s municipal hospital system, and community organizations to address disparities in testing, infection, and follow-up care.

Materials/Methods: This study used a community-engaged, mixed-methods approach across four integrated aims. First, sustainable engagement structures were created by partnering with NYCHA Resident Associations, community-based organizations, and municipal agencies to guide testing and vaccination strategies across multiple NYCHA developments. Next, granular public health and testing site data were triangulated to quantify inequities in testing access, testing rates, and SARS-CoV-2 positivity, with maps and neighborhood-specific surveillance used to identify developments with low access or high case burden. Mixed-methods investigations were then conducted with NYCHA residents and community partners to identify barriers to testing, isolation challenges, privacy concerns, and financial burdens associated with positive test results. Finally, a comparative effectiveness study evaluated a community health worker model that offered a menu of community-informed testing options, with and without navigation support, including on-site testing, mobile testing vans, door-to-door testing, and home-testing approaches.

Outcome/Impact: The study findings identified specific barriers and facilitators unique to NYCHA communities and informed strategies that increased testing uptake through community-aligned approaches. The comparative effectiveness results guided future deployment of community health worker and navigation-based models in underserved urban neighborhoods. Insights from this work supported more equitable COVID-19 responses for public housing residents and provided a framework for improving testing, prevention, and follow-up care in similar settings nationwide.