Critical lessons from a pragmatic randomized trial of home-based COVID-19 testing in rural Native American and Latino communities.

Publication Title

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association

Authors

Eliza Webber
Sonia Bishop
Paul K Drain
Virgil Dupuis
Lorenzo Garza
Charlie Gregor
Laurie Hassell
Geno Ibarra
Larry Kessler
Linda Ko
Alison Lambert, Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA.Follow
Victoria Lyon
Carly Rowe
Michael Singleton
Matthew Thompson
Teresa Warne
Wendy Westbroek
Alexandra Adams

Document Type

Article

Publication Date

3-6-2024

Keywords

washington; pmrc; spokane; covid-19; diversity

Abstract

PURPOSE: Native Americans and Latinos have higher COVID-19 infection and mortality rates and may have limited access to diagnostic testing. Home-based testing may improve access to care in rural and underserved populations. This study tests the effect of community health worker (CHW) support on accessibility, feasibility, and completion of COVID-19 home testing among Native American and Latino adults living on the Flathead Reservation in Montana and in Yakima Valley, Washington.

METHODS: A two-arm, multisite, pragmatic randomized controlled trial was conducted using block randomization stratified by site and participant age. Active arm participants received CHW assistance with online COVID-19 test kit registration and virtual swabbing support. The passive arm participants received standard-of-care support from the kit vendor. Logistic regression modeled the association between study arm and test completion (primary outcome) and between study arm and test completion with return of valid test results (secondary outcome). Responses to posttest surveys and interviews were summarized using deductive thematic analysis.

FINDINGS: Overall, 63% of participants (n = 268) completed COVID-19 tests, and 50% completed tests yielding a valid result. Active arm participants had higher odds of test completion (odds ratio: 1.66, 95% confidence interval [1.01, 2.75]). Differences were most pronounced among adults ≥60 years. Participants cited ease of use and not having to leave home as positive aspects, and transportation and mailing issues as negative aspects of home-based testing.

CONCLUSIONS: CHW support led to higher COVID-19 test completion rates, particularly among older adults. Significant testing barriers included language, educational level, rurality, and test kit issues.

Specialty/Research Institute

Infectious Diseases

Specialty/Research Institute

Population Health