Association of race, ethnicity, and housing stability with COVID-19 testing method by investigators in underserved populations 2020-2023.

BACKGROUND: Expanding SARS-CoV-2 testing was a critical part of community-based health efforts during the COVID-19 pandemic. In the RADx-UP consortium, a large NIH-funded network of community-engaged researchers in the United States, investigators were able to choose between PCR- and antigen-based testing strategies in community-based research settings. Data analyzing how COVID-19 diagnostics are chosen and utilized in research of vulnerable and underserved populations is limited. OBJECTIVES: To examine the association of race, ethnicity, and housing stability with a PCR- or antigen-based testing strategy within COVID-19 testing projects in the RADx-UP consortium. METHODS: Testing protocols and investigator survey data describing target populations for community-engaged research projects were analyzed for association between race, ethnicity, and housing stability with SARS-CoV-2 test type. Community-engaged research projects were included if they were funded and approved to use PCR- and/or antigen-based COVID-19 testing by the RADx-UP testing core between 2020 and 2023. Multivariable adjustment to assess for confounding was then performed using rurality, project size, pandemic phase, and census region. RESULTS: Sixty-seven projects (representing 479,410 participants) were included in the analysis. Overall, 24 (36%) projects chose an antigen-only testing strategy compared to 43 (64%) that chose a PCR-based strategy. No significant differences in distribution were seen in inclusion of PCR-testing by race (16 of 21 for Black race versus 27 of 46 for non-Black race, p = 0.198), ethnicity (22 of 33 for Hispanic ethnicity versus 21 of 34 for non-Hispanic ethnicity, p = 0.765), or housing stability (10 of 17 for unstable housing versus 33 of 50 for stable housing, p = 0.728) within intended population. CONCLUSION: Race, ethnicity, and housing stability of an underlying vulnerable population was not significantly associated with the decision by community investigators regarding which COVID-19 testing strategy was most appropriate. Future research efforts should remain vigilant to offer emerging diagnostic technologies in the most equitable and appropriate ways.

Duke Scholars

Author Gayani Tillekeratne Medicine, Infectious Diseases

Author Lisa Wruck Biostatistics & Bioinformatics, Division of Biostatistics

Author Susanna Naggie Medicine, Infectious Diseases

Author Micah Thomas McClain Medicine, Infectious Diseases

Author Christopher Wildrick Woods Medicine, Infectious Diseases