A CHW checks in a patient for COVID-19 testing at a mobile site. Photo courtesy of Eric Zentmyer, SDSU.

Imagine you’re living in a U.S. city that’s a COVID-19 hot spot and you find out that you’ve been exposed to the virus. You have to figure out where to go for testing, arrange transportation to the testing site, drop the kids off at a relative’s home, and wait in line — perhaps for hours — to get the test. Then you have to isolate yourself at home while you wait for the results.

The barriers to testing — when testing can help save lives — seem sky-high, especially among the hardest-hit communities.

A part of the National Institutes of Health’s Rapid Acceleration of Diagnostics (RADx) initiative, the RADx Underserved Populations (RADx-UP) program is focusing on assessing and removing barriers to testing for populations disproportionately affected by the pandemic, including African Americans, American Indians/Alaska Natives, Latinos/Latinas, Native Hawaiians, older adults, pregnant women and those who are homeless or incarcerated. RADx-UP aims to develop strategies to reduce disparities in COVID-19 testing by supporting more than 70 projects across the country that have existing community partnerships.

The Communities Fighting COVID! project integrates a major research center with more than a dozen community organizations and a network of community health workers to boost COVID-19 testing among populations in San Diego. Logo design by Richard Awad Design.

Pivoting in response to a crisis

Susan M. Kiene, Ph.D., professor of global health at San Diego State University (SDSU), and her colleagues at SDSU’s School of Public Health understand both the importance of fast, accurate, and accessible COVID-19 testing and the benefit of providing a service where people feel comfortable and connected. They already had a valuable resource to improve access to COVID-19 testing: a network of trained community health workers (CHWs) in San Diego who speak a variety of languages and come from diverse communities hit hard by the pandemic. The researchers also had strong partnerships with organizations connected to the African American, Latino/a, Filipino, and Arabic-speaking communities. 

“My co-principal investigators are experts in working with San Diego communities, while I have experience with researching community-based HIV testing programs in sub-Saharan Africa,” Kiene said. “The RADx-UP grant brought our strengths together.” Kiene is the lead principal investigator for the Communities Fighting COVID! (CFC) project.

SDSU has had a major research center supported by the National Cancer Institute (NCI) since 2015. “Getting RADx-UP support through our main NCI grant offered us a chance to pivot and start the Communities Fighting COVID! project to find ways to boost coronavirus testing for groups that SDSU public health researchers were already working with,” said Kiene.

Kiene and her colleagues were notified in September 2020 that the CFC project had been approved for RADx-UP funding. Within a few weeks, the study team had launched COVID-19 home testing; the project recently expanded to include mobile testing.

The project’s goal is to provide more than 40,000 COVID-19 tests over the two-year project. At the same time, the study team will collect data through interviews to understand people’s experiences with testing so that the process can continuously be improved. By January 2021, more than 1,000 people had been interviewed and tested.

At the heart of the CFC project is the CARE Team. Ten community organizations are represented on the CARE team. Image courtesy of Corinne McDaniels-Davidson, Ph.D., MPH, SDSU School of Public Health.

Working hand in hand with communities

The main barrier to COVID-19 testing right now is high demand, according to Kiene. At the county’s free testing sites, people may have to wait hours to get tested. The CFC project means that more tests are available for communities. And CFC testing is often faster, since the sites are local and people get the results of rapid tests within about half an hour.

The project is fully integrated into diverse San Diego communities through CHWs and through community organizations represented on the project’s COVID Community Advocates for testing Reach and Equity (CARE) team.

At the heart of the CFC project is the COVID CARE team. Ten community organizations are represented on the COVID CARE team. Image courtesy of Corinne McDaniels-Davidson, Ph.D., M.P.H., SDSU School of Public Health.

CHWs are trusted, respected members of the community who serve as a bridge between their community members and the health care system. They wear many hats: health educators, navigators who guide people through the health care system, coaches for managing diseases, and positive role models.

The project team also draws upon the strengths and social connections of local community organizations through the COVID CARE team. “Community organizations provide a lot of support and infrastructure that people rely on. Our COVID CARE team partners are in touch with people and know what they need,” Kiene said. “Providing services for people within organizations where they’re already comfortable might be a way to reach some people who otherwise might be reluctant to go to other settings.”

Kiene credits the COVID CARE team for coming up with ideas to help the research succeed. “The COVID CARE team members are amazing leaders who are passionate about wanting to tackle COVID-19 in their own and other communities,” she said. “The team guides our decisions about where to locate test sites within San Diego, and they identify the best spots within an area to set up testing. They also introduce us to community leaders and advise us on the best ways to do outreach.”

For example, the team recommended that the researchers communicate with study participants about progress throughout the project, not just at its end. In response, the researchers added a step to ask for people’s permission to be contacted by email. Emails go out periodically to update study participants about what the researchers are learning and important facts about COVID-19.

A CHW prepares to collect a nasal swab sample at a mobile CFC testing site. Photo courtesy of Eric Zentmyer, SDSU.

Looking ahead

Kiene hopes that the legacy of this project will be a strong, adaptable infrastructure built on trust, community connections, and trained CHWs. CFC could be a model for more research projects and new public health initiatives.

”Once a COVID-19 vaccine becomes available that can be at room temperature for longer periods and doesn’t require cold chain transport and storage, I envision our project being a launchpad for studies of vaccine distribution in a community-based way,” Kiene said. “We would be in a good position to administer vaccines in our communities or, short of that, to provide referrals to vaccination centers.”

Kiene also underscored the importance of balancing research with public health service. “Research is important, but we have to remember that we’re talking about people who may have COVID-19, and they need to get tested,” she said. “As scientists, yes, we want to advance science, and, yes, we want to understand how to improve access to testing, but we have to make sure we are serving people in the process.”

Where can I go to learn more?

Read About This Project on NIH RePORT

The National Cancer Institute’s COVID-19 Resources

News and Stories

Read stories about the efforts underway to prevent, detect, and treat COVID-19 and its effects on our health.

NIH COVID-19 Resources by Topic

COVID-19 research information and resources by topic from NIH institutes and centers