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

The Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) initiative supports supplements to individual NIH awards to increase COVID-19 testing among underserved populations. Leveraging the infrastructure of another project in NYC (National Cancer Institute, R01CA220591, Evaluation of Smoke-Free Housing Policy Impacts on Tobacco Smoke Exposure) and a longstanding set of partnerships among the NYC Housing Authority (NYCHA) and their resident boards, the NYC Health Department, NYC's municipal hospital system, NYU Grossman School of Medicine, and community partnerships, this study executed community-engaged investigations to improve COVID-19 testing for NYCHA residents. NYCHA is the largest public housing authority in North America, with 400,000 official residents living in 15% of the nation's public housing units. NYCHA provides a home to nearly 5% of NYC residents. Developments are spread throughout the city but concentrate in lower-income neighborhoods. Median family income is $20,000, and approximately 90% of NYCHA residents are Black or Hispanic. Apartment turnover is low due to subsidized rental assistance, and developments have organized resident associations, which facilitate capacity for sustained engagement and opportunities for community activation. Aim 1: Develop Sustainable Community Engagement Structures to Guide Current and Future Deployment of Evidence-Based COVID-19 Testing and Vaccination Options for NYC Public Housing Residents. In partnership with a network of community-based organizations (CBOs), NYCHA Resident Associations, and several municipal agencies, a platform for NYCHA-facing initiatives to reduce disparities in COVID-19 morbidity and mortality was established. The platform spanned distinct NYC neighborhoods to give NYCHA residents a voice in shaping COVID-19 testing initiatives. Aim 2: Quantify Inequities in COVID-19 Testing and SARS CoV-2 infection among Public Housing Residents. Triangulation occurred across granular and timely data sources to determine baseline testing and COVID-positivity rates among NYC's public housing resident population, with an emphasis on subgroups with (a) limited access to testing sites, (b) adequate access to testing sites but low testing rates, and (c) high positive test rates. Development-specific maps of testing sites were promulgated and prospective surveillance of testing using routine public health data was established. Aim 3: Discover Facilitators and Barriers to Testing, Isolation, and Follow-Up Care. To guide improvements to COVID-19 testing services, a mixed methods approach was applied to identify barriers to testing, implications and financial burden associated with a positive test result, feasibility of self-isolation for positive results, acceptability of tracing contacts, and privacy concerns. NYCHA residents and CBO partners were engaged in primary data collection and analysis in order to foster a shared understanding of prevention, testing, and management of COVID-19 among public housing residents. Aim 4. Test Community-Informed Strategies to Increase Testing Uptake. Leveraging an array of recently-launched testing initiatives across NYC, including on-site testing clinics, mobile vans, and door-to-door testing, a comparative effectiveness study was conducted to test the impact of a community health worker (CHW) model delivering a menu of community-informed testing options with and without navigation support, including home-testing strategies, on acceptance and uptake of COVID-19 screening tests.