DOI: 10.7272/q6445jqm
title: Evaluation of a novel community-based COVID-19 ‘Test-to-Care’ model for low-income populations

description: Background: After a COVID-19 diagnosis, vulnerable populations face
 considerable logistical and financial challenges to isolate and
 quarantine. We developed and evaluated a novel, community-based approach
 (‘Test-to-Care’ Model) designed to address these barriers for
 socioeconomically vulnerable Latinx individuals with newly diagnosed
 COVID-19 and their households. Methods: This three-week demonstration
 project was nested within an epidemiologic surveillance study in a
 primarily Latinx neighborhood in the Mission district of San Francisco,
 California. The Test-to-Care model was developed with input from community
 members and public health leaders. Key components included: (1) provision
 of COVID-19-related education and information about available community
 resources, (2) home deliveries of material goods to facilitate safe
 isolation and quarantine (groceries, personal protective equipment and
 cleaning supplies), and (3) longitudinal clinical and social support.
 Newly SARS-CoV-2 PCR-positive participants were eligible to participate.
 Components of the model were delivered by the Test-to-Care team which was
 comprised of healthcare providers and community health workers (CHWs) who
 provided longitudinal clinic- and community-based support for the duration
 of the isolation period to augment existing services from the Department
 of Public Health (DPH). We evaluated the Test-to-Care Model using the
 Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM)
 Framework and drew upon multiple data sources including: programmatic
 data, informal interviews with participants and providers/CHWs and
 structured surveys among providers/CHWs. Results: Overall, 83 participants
 in the surveillance study were diagnosed with COVID-19, of whom 95%
 (79/83) were Latinx and 88% (65/74) had an annual household income
 &lt;$50,000. Ninety-six percent (80/83) of participants were reached
 for results disclosure, needs assessment and DPH linkage for contact
 tracing. Among those who underwent an initial needs assessment, 45%
 (36/80) were uninsured and 55% (44/80) were not connected to primary care.
 Sixty-seven percent (56/83) of participants requested community-based CHW
 support to safely isolate at their current address and 65% (54/83) of all
 COVID-19 participants received ongoing community support via CHWs for the
 entire self-isolation period. Participants reported that the intervention
 was highly acceptable and that their trust increased over time – this
 resulted in 9 individuals who disclosed a larger number of household
 members than first reported, and 6 persons who requested temporary
 relocation to a hotel room for isolation despite initially declining this
 service; no unintended harms were identified. The Test-to-Care Model was
 found to be both acceptable and feasible to providers and CHWs. Challenges
 identified included a low proportion of participants linked to primary
 care despite support (approximately 10% after one month), and insufficient
 access to financial support for wage replacement. Conclusions: The
 Test-to-Care Model is a feasible and acceptable intervention for
 supporting self-isolation and quarantine among newly diagnosed COVID-19
 patients and their households by directly addressing key barriers faced by
 vulnerable populations.