Adapting Community-Based Task-Shifting for the COVID-19 Response Among Underserved Populations in Piedmont, North Carolina (ACT UP)

Background: The purpose of this study was to reduce disparities in COVID-19 testing, prevention, and care among Black and Hispanic/Latinx communities in rural central North Carolina. These populations experienced disproportionate infection and mortality rates due to structural and social barriers, yet had not received a response proportional to their level of risk. The study sought to adapt and apply a successful global HIV response strategy and community-based task shifting to expand access to COVID-19 testing, vaccination, and linkage to care in underserved populations.

Materials/Methods: This study employed a community-based implementation model that trained trusted local community members to perform outreach, administer COVID-19 tests, and facilitate referrals to healthcare and vaccination services. By adapting the task-shifting framework from HIV response programs, the study redistributed public health responsibilities to community-level workers, enabling broader coverage in rural and low resource settings. The implementation strategy focused on reaching marginalized populations who had limited access to testing sites and healthcare services. Data collection involved tracking health service outcomes such as testing uptake, vaccination rates, and successful linkage to care, as well as implementation metrics including feasibility, acceptability, and sustainability within the local context.

Outcome/Impact: The study expanded COVID-19 testing access to rural and underserved Black and Hispanic/Latinx communities that had previously been excluded from traditional testing efforts. The study generated valuable evidence supporting community-based task shifting as an effective strategy for delivering equitable pandemic response measures. Findings demonstrated that community-led implementation approaches improved testing participation, strengthened trust in public health systems, and could be adapted for other prevention initiatives such as vaccination delivery and chronic disease management in similar settings.