Increasing representation of Black communities in COVID-19 home testing and surveillance data - Abstract
Black communities in the U.S. have disproportionately experienced adverse outcomes attributable to the
COVID-19 pandemic. While COVID-19 cases and deaths have declined in recent months, emergent variants
continue to pose threats to the health of Black communities and others. COVID-19 testing has recently shifted
from primarily point-of-care testing to widespread use of rapid home antigen tests. Home testing may be
preferable to clinic-based testing for Black persons, many of whom have a high degree of well-founded,
historically based mistrust of the medical system, but very little is currently known about knowledge, attitudes,
and behaviors surrounding COVID-19 home testing among Black people. In addition to challenges related to
affordability and accessibility of home testing, the privacy afforded by home testing comes at the expense of
surveillance information. Home tests are rarely reported to public health surveillance, and specimens are
unavailable for genetic sequencing and variant detection. This results in a substantial gap in public health
knowledge about COVID-19 burden of disease and circulating variants, which may be particularly problematic
for Black communities with higher risk for adverse outcomes. We propose a pre-post intervention study based
in Black communities in Atlanta, GA to assess willingness of research participants to use a COVID-19 rapid
home test and to simultaneously mail a self-collected anterior nares sample to a commercial laboratory for
confirmatory PCR testing. We will provide culturally competent oral and illustrated written communication
messages encouraging continued COVID-19 vigilance and home testing alongside self-collection of a
specimen for mail-off testing. These messages will be packaged with a home test kit for rapid testing and self-
collecting and mailing a second specimen to a laboratory. If a subset of home testers were willing to self-collect
and mail a specimen for confirmatory testing, multiplier methods could be used to estimate burden of disease
and circulating variants among home testers. However, people with medical mistrust may not elect to share
biological specimens for surveillance purposes. We aim to understand motivations and barriers for using this
type of testing modality in Black communities while also assessing general knowledge, attitudes, and
behaviors related to home testing. Specific aims are to: (1) Develop culturally appropriate, empowering
communications strategies underscoring the importance of home COVID-19 testing for individual and public
health; (2) Assess knowledge, attitudes, and behaviors regarding COVID-19 rapid home testing among socio-
demographically diverse Black communities; (3) Assess willingness to provide, in conjunction with a rapid
home test, a self-collected specimen to a laboratory for confirmatory COVID-19 testing; (4) Conduct in-depth
interviews with persons completing (N=10) and not completing (N=10) the study-provided home test to further
improve communications strategies using participants’ open-ended reflections on intervention effectiveness.
