COVID Self-Testing Through Rapid Network Distribution (C-STRAND)

Background: The purpose of this study was to examine whether secondary distribution of COVID-19 self-testing kits could increase testing uptake in underserved Black and Latinx communities that experienced disproportionately high infection rates but lower access to testing. Self-testing offered convenience and privacy, but often failed to reach individuals with limited access to health services. Secondary distribution, where individuals share self-tests within their social networks, had the potential to expand testing reach, reduce reliance on medical systems, and support contact tracing.

Materials/Methods: In collaboration with the Public Health Management Corporation, a 1:1 randomized trial was conducted with individuals receiving care at Federally Qualified Health Centers in Philadelphia. The study compared secondary distribution of SARS-CoV-2 self-tests to standard referrals to determine effects on test uptake. The study also assessed whether distributing self-tests to close contacts of COVID-19 positive individuals increased case detection. A mixed methods strategy was used to identify social, ethical, economic, and behavioral factors that influenced uptake and acceptability.

Outcome/Impact: The study engaged community partners to reach individuals experiencing housing instability, immigration-related barriers, and significant medical comorbidities such as HIV, viral hepatitis, and substance use disorders. The study findings informed strategies for adapting and scaling this model to improve testing access in communities disproportionately affected by COVID-19.