Community-based Testing and Primary Care to Mitigate COVID-19 Transmission (2020-2021)

Background

COVID-19 has exposed a need for rapid, accessible testing and clinical assessment in the most vulnerable groups, along with a need for effective care management that reaches communities in the longer term. In Durham County, Black and Latinx communities bear disproportionate rates of COVID-19 morbidity and mortality. As of June 2020, Latinx individuals from Duke University Health System (DUHS) were 13 times more likely to test positive for COVID-19 than non-Hispanic white individuals but were 20% less likely to be tested relative to their proportion of the population.

COVID-19 services have largely been implemented within existing health service infrastructure and networks that exclude Black and Latinx communities, an approach that has predictably led to the current disparities and resulting inability to mitigate the pandemic in the U.S. Without new, community-based models of care delivery, this problem will continue to worsen.

Project Description

This project team will address COVID-19 inequities in Durham County by strengthening collaboration between clinical, policy and community partners and assessing long-term sustainability. The roots of health disparities are complex and include underlying structural racism and various socioeconomic factors.

To address these issues, the team will:

  1. Implement a community-based mobile testing program (Mobile Testing Team) for COVID-19 in Durham County: Team members will work closely with community partners to illuminate the historical contexts of health disparities in order to ensure that services are culturally sensitive. Team members will then investigate the process and lessons of the pilot program. By offering information and enrollment to patients at community sites, team members will increase equity in COVID-19 research studies.
  2. Investigate care delivery models for strengthening primary care and community-based care: Team members will assess the scalability of the pilot program to provide community-based clinical services in partnership with community organizations. Through this assessment, the team will identify culturally appropriate, community-based care efforts that meet the specific health needs of the community. Team members will develop case studies and disseminate results of the pilot program to key stakeholders and agencies involved in COVID-19 response. This team’s research will inform care delivery redesign efforts and policy discussions in North Carolina concerning health disparities within underserved communities.

Anticipated Outputs

Mobile Testing Team pilot program; manuscripts; publications; case studies of delivery models; policy brief

Timing

Fall 2020 – Summer 2021

  • Fall 2020: Launch pilot Mobile Testing Team; establish community advisory panel; develop COVID-19 material and resource guides; start data collection on COVID-19 epidemiology; conduct stakeholder interviews; write case studies; start manuscript draft
  • Spring 2021: Continue analyzing Mobile Testing Team data; write issue brief; continue manuscript writing; draft publication; develop plan for dissemination of reports
  • Summer 2021: Finalize manuscript and publication; submit reports to academic journals

 

Image by Staff Sgt. Mary Junell, North Carolina National Guard, public domain

Mobile testing.

Team Leaders

  • Andrew Flynn, School of Medicine-Family Medicine and Community Health
  • Gabryel Garcia-Sampson, School of Medicine-Family Medicine and Community Health
  • Viviana Martinez-Bianchi, School of Medicine-Family Medicine and Community Health
  • Gabriela Plasencia, School of Medicine-Family Medicine and Community Health
  • Andrea Thoumi, Margolis Center for Health Policy

/graduate Team Members

  • Sebastian Gutierrez, Biomedical Engineering-MS
  • Keren Hendel, Masters of Public Policy
  • Njideka Ofoleta, Masters of Public Policy
  • Courtney Young, Bioethics and Sci Policy - AM

/undergraduate Team Members

  • Emine Arcasoy, Biology (BS), Global Health (AB2)
  • Nikhil Chaudhry
  • Alexandra Chukwuma, Chemistry (BS)
  • Michael Dieu
  • Michelle Huang
  • Adaora Nwosu, Neuroscience (BS)
  • Caroline Palmer
  • Zachary Rene, Psychology (AB)
  • Dru Ricci, Sociology (AB), Global Health (AB2)

/yfaculty/staff Team Members

  • Rushina Cholera, School of Medicine-Pediatrics: Primary Care Pediatrics
  • Irene Felsman, School of Nursing
  • Anne Fields, School of Medicine-Family Medicine and Community Health
  • Beverly Gray, School of Medicine-Obstetrics and Gynecology
  • Danya Holtzman, School of Medicine-Family Medicine and Community Health
  • Truls Ostbye, School of Medicine-Family Medicine and Community Health
  • Mark Sendak, Duke Institute for Health Innovation
  • Mina Silberberg, School of Medicine-Family Medicine and Community Health
  • Nicholas Turner, School of Medicine-Medicine: Infectious Diseases

/zcommunity Team Members

  • Pablo Friedmann, Durham Public Schools
  • Erin Van Scoyoc, Carrboro Community Health Center (Piedmont Health)

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