Addressing Disparities in Access to COVID-19 Testing in Arizona

Background: This study investigated multilevel barriers to COVID-19 testing encountered by vulnerable and underserved communities in Arizona. A research team of university-based investigators and community partners designed and is implementing a cultural congruent COVID-19 intervention since November 2020. Community health workers (CHW) -also known as promotoras- play a key role in the intervention, they make testing accessible to members of underserved communities and provide follow-up wraparound services with those testing positive. We examined the characteristics of zip code level geographical locations served by the program and identified as “communities of urgent testing needs” (CUTN). The study is advancing much needed knowledge about key environmental characteristics associated with the existing COVID-19 disparities in testing and vaccination in Arizona.

Methods: Data of community members tested by the CHW-led COVID-19 testing outreach were gathered while they consented to saliva-based COVID-19 testing between November 2020 and March 2021. This program tested 2,549 participants; their overall positivity rate was 22.2%. Our study examined demographic factors, whether a participant had an email address and whether tested participants had viewed their results available online within 48 hours. Having an e-mail account became a critical piece of information for streamlined access to online portals for registering and viewing their COVID-19 test results on a timely fashion.

To assess environmental attributes of CUTN, we synchronized data of multiple sources, including bi-weekly zip code level COVID-19 case numbers, locations of COVID-19 testing sites, and zip code level social determinants of health (SDOH) (e.g., Census 2010, existing safety net clinic). On a biweekly basis, we identified CUTN with case numbers relative to testing sites available for each zip code area. Collectively, we had identified 87 zip code areas as CUTN out of 294 zip code areas. This study conducted logistic regression analysis to find zip code level attributes for being a CUTN at p-value cutoff of 0.05.

Results: As for participants, 53.2% were Latinx, 10.3% were non-Latinx Whites, 5.2% were Blacks, and 2.4% American Indians and Alaska Natives. 35.8% of people tested did not have an email address, 42.5% did not view their own results available online system within 48 hours, and 35.7% had never accessed their testing results online, whom the CHWs had reached out via phone or other means (e.g., working with local community organization). Significant attributes of a zip code having a CUTN designation were the ethnicity/race of those tested and living in rural areas (Latinx odds ratio [OR] = .1.05, P < 001), American Indian OR=1.03, P < 001), Black OR=1.14, P < 01), and urban community OR=0.42, P < 05).

Implications: The findings offer preliminary evidence illustrating how and why the COVID-19 pandemic accentuated existing health disparities among vulnerable and underserved communities. The SDOH highlighted by the health disparities literature -such as race and ethnicity, the digital divide, and rural/urban inequities- seem to be most responsible for disparities in access to COVID-19 testing. CHW-led culturally congruent interventions are a promising approach to address the testing and vaccination disparities related to COVID-19 and future public health crises.