Abstract
BACKGROUND: Many off-site COVID-19 testing centers (OSCTCs) are struggling with strategies to serve vulnerable populations who have some of the highest rates of COVID-19 cases, hospitalizations, and deaths. Inter-OSCTC sharing of successful protocols and systems has been hampered by evolving resource constraints, the changing science of testing, and ever increasing COVID-19 case counts. OBJECTIVE: The aim of the present study was to identify promising approaches to testing vulnerable populations. METHODS: We conducted a qualitative study using semi-structured interviews with 26 leaders of OSCTCs and public health departments across the United States between June 8th and August 10th, 2020. All interviews were coded utilizing oral coding via rapid identification of themes from audio recordings, and analysis occurred concurrently with data collection to assess when saturation was achieved. RESULTS: Six main themes emerged highlighting approaches to testing within vulnerable populations including: 1. Expanding services to support health and health-related needs beyond COVID-19; 2. Gaining community trust; 3. Developing and leveraging community partnerships; 4. Promoting clear and creative messaging; 5. Prioritizing patient experience; and 6. Managing patient results. CONCLUSIONS: Testing among the vulnerable not only helps those at highest risk of severe disease or death from COVID-19, but also presents a critical opportunity to control viral spread within and from these communities. Reaching vulnerable populations is challenging and requires multi-sector collaboration, additional funding, and high levels of creativity and flexibility.