Building Bridges to COVID Testing in Alabama’s Underserved Communities

Building Bridges to COVID Testing in Alabama’s Underserved Communities

The University of Alabama at Birmingham leveraged its existing relationships with underserved communities to maximize the effectiveness of its COVID-19 testing programs.

Its Minority Health & Health Disparities Research Center (MHRC) is leading the institution’s testing clinic program in Black and Latinx communities in the city and beyond. Testing is being conducted three to five days a week at multiple sites, generally in the parking lots of churches serving predominantly Black communities.

The approach takes a cue from MHRC’s founding principles of community-based participatory research, engaging communities in dialogue from the outset and tuning into their needs, challenges, and perspectives, its leaders said.

“Our model is derived from the community,” Theresa Wallace, PhD, program director of the MHRC’s Live HealthSmart Alabama, told MedPage Today. “Building community trust and buy-in opens the doors to a long-lasting conversation and relationship.”

Leaders of the testing initiative offered insights into what it’s like to build and run a COVID-19 testing program for underserved communities.

Confronting Fears

Initially, UAB offered testing at one fixed location, but it became clear that they weren’t adequately reaching Birmingham’s underserved communities, said Bill Curry, MD, senior vice president for population health and associate dean of rural and primary care at UAB Health System.

So Curry turned to MHRC director Mona Fouad, MD, MPH, aware that her team had the willingness and know-how to reach into those communities.

“We listened to church pastors and other leaders, and they told us several things that needed to first be addressed,” Fouad told MedPage Today. The first was to help bring clarity to sometimes confusing, often shifting guidelines. The second was to alleviate fear of the COVID-19 test.

The team developed concise messaging, distributed fliers throughout neighborhoods, and shared information on social media. They erected yard signs in parks and gained permission from pastors to set up testing sites on weekdays.

As for the fear, Curry said there was a mistaken notion that testing involved an injection. “That sounds too much like experimentation, and [Alabama] is the home of the Tuskegee syphilis study,” he said.

Though the Tuskegee study was shut down a half century ago, its haunting legacy lingers, said Tiffany Osborne, MHRC’s director of community engagement.

“In COVID-19 focus groups, participants have said, ‘I’m not getting tested. That’s how you get COVID-19,'” Osborne said. “So we spend a lot of our time educating.”

A participant undergoes a COVID-19 test at one of UAB’s clinics. Photo by Quez Shipman.

Key Community Partners

The partnerships MHRC has forged over the years have proven invaluable in this crisis. The connection might be with a community coalition or, Wallace said, “the lady who sits on her front porch and knows everything about her community. She’s definitely a person we want to have involved.”

Faith leaders, Osborne said, are typically among the most trusted members of underserved communities. The MHRC relies on pastors and other church leaders to get the word out, she said, “because so much of bringing this together is based on trust.”

Sonjanetta Houston is a member of Faith Chapel, a church with a predominantly Black congregation. She serves as general manager of the church’s event facility. Given that it’s closed due to the pandemic, her role these days is largely in outreach.

Free COVID-19 testing at her church, she said, has been “a blessing.”

Faith Chapel’s staff has worked diligently to keep congregants informed about the virus, regularly sending out messages through social media and its website. Houston said church members are, generally speaking, adhering to the guidelines. They’re aware that elevated rates of diabetes, hypertension, and obesity mean that African Americans are at greater risk of dying from COVID-19.

But there are those, she said, who would prefer to remain uninformed and are resistant to prevention and testing. In hosting COVID-19 testing, the church puts the weight of its influence behind it. Perspectives are more easily changed.

Faith Chapel “has sought to be of support to the community as an information site, a food-distribution hub, and a COVID-19 testing site,” said Dr. Michael W. Wesley, Faith Chapel’s senior pastor. “Whatever community ministry services we could provide or arrange have enabled us to be viable during such a dark period for many.” The arrival of the MHRC team, he attests, “was welcome news to our congregation and community.”

Problem Solving

A great deal of time is also spent on test-day logistics. Tents and tables must be erected and struck, secure laptops must be networked, cones must be laid to safely manage traffic. A lab team is deployed each day; it must work efficiently and with compassion.

Medical records must be securely processed. Those who call in requesting to be tested are assigned a medical-record number and testing-team members are assigned IDs to connect them with one another.

Those tested generally get their results within 24 hours. If the test comes back negative, they’re given encouragement in how to stay healthy. If it’s positive, they’re advised on how to properly quarantine, what symptoms to look for, and what resources are available to them – what to do if they don’t have a primary care provider or health insurance.

Patient navigators, many of whom come from the communities they’re assisting, guide those tested through the process and help engage them with needed services.

Wallace stresses the importance of being sensitive to the challenges many of those served face each day, the social determinants that affect their health. “They may not see the virus as their biggest threat because they have so many other pressing needs,” she said.

Diane Williams, a patient navigator, said transportation is the barrier she most frequently addresses. She’s arranged free rides to the testing sites. Sometimes, people have resources around them but are unaware of what’s available, or are simply reluctant, or too proud, to ask for help, she added.

“We’re problem-solvers,” said navigator Elise McLin. “We help people think through things.”

Continued Partnership

Some testing days are more productive than others. In mid-July, cars lined up well in advance of the first appointment. On a blustery September day at East Lake United Methodist, few showed up; winds toppled a tent.

As she waited out the storm on that September day, testing coordinator Cynthia Johnson contemplated COVID fatigue among those they’re serving; people anxious to return to normalcy.

The call volume for testing has dropped, and that worries her.

“We keep telling people, through our yard signs, through Facebook, our website, through the churches that we partner with and the businesses we collaborate with, and through our navigators, to please don’t let your guard down,” she said. “Be vigilant.”

Johnson also acknowledged the stress of the long hours of demanding work experienced by her team members.

Has she at any moment felt as if it was just too much – that the stress, the hours away from her family, the risk of exposure, was more than she should be taking on?

“I think I’d probably be lying if I said no,” she said. But team members lift one another. “We discuss how to stay safe, what works and doesn’t … and we develop something that’s workable for everyone.”

MHRC steering committee member Julie Schach said the team convenes each morning at 9 a.m. for a virtual huddle to discuss the day’s procedures and challenges. “On site, we also usually team huddle right before we begin testing to make sure we’re all ready to begin the day,” she said.

Throughout, the conversation with the community continues. The MHRC is further building its database of health information and those tested are asked if they’re interested in participating in future studies.

Kimberly Alexander serves on the city council of Bessemer, a town just southwest of Birmingham in which the MHRC has provided testing. She’s also a traveling nurse who’s been caring for COVID-19 patients in New York City, Houston, Oakland, and elsewhere. She’s witnessed a lot of death. But she sees something positive emerging from so much loss.

“You have some of the biggest hospitals in the world teaming up with some of the smallest organizations to make a difference in underserved communities,” she said. “Before this pandemic, I didn’t know who Dr. Theresa Wallace was. Now I can call her anytime.”

It feels like a partnership, Alexander said.

When the pandemic has passed, Wallace said, “what continues is our relationship and our conversation, and knowing that we can go back to that community and reengage them in other programs that may be of interest to them. That’s the foundation that we build on.”

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