Abstract
BackgroundThis paper evaluates the increase in coverage and use of Covid-19 testing services for vulnerable and hard-to-reach populations through the introduction of community-based walk-up sites in New Orleans, LA. While most GIS work on Covid-19 testing coverage and access has used census tract or ZIP code aggregated data, this manuscript is unique in that it uses individual level demographics and exact addresses to calculate distances actually traveled by patients.MethodsWe used testing data recorded for 9721 patients at 20 sites operating in May–June 2020. The dataset includes detailed age, race and ethnicity, and testing results as well as the exact address of each individual. Using GIS, we estimated changes in testing coverage for minority neighborhoods and calculated the actual distance covered by individuals. Logistic regression and multivariate linear regression were used to identify socio-demographic variables associated with distance travelled to and used of nearest testing site. We used a secondary dataset from drive-through sites to evaluate change in coverage at the census tract level for the metropolitan area.ResultsWalk-up sites significantly increased testing availability in New Orleans, and specifically in minority neighborhoods. Both African Americans and Asians were more likely (14.7 and 53.0%) to be tested at the nearest walk-up site. They also covered shorter distances to get tested. Being elderly was also significantly and positively associated with testing at the nearest site. Hispanics, however, were not associated with increased proximity to and use of nearest sites, and they traveled an additional 0.745 km to get tested. Individuals who tested positive also travelled significantly longer distances to obtain a test.ConclusionsWalk-up sites increased testing availability for some vulnerable populations who took advantage of the sites’ proximity, although inequalities appear at the metropolitan scale. As cities are planning community vaccination campaigns, mobile, walk-up sites appear to improve both coverage and accessibility for hard-to-reach populations. With adequate technical (vaccine dose refrigeration) and messaging (addressing reticence to immunization) adaptations, they could constitute a key complementary approach to health facility points of delivery.
Highlights
In the months following the Covid-19 outbreak in the United States, hospitalization and mortality data clearly indicated that racial and ethnic minorities and socioeconomically deprived areas were bearing a higher burden of disease and death than other groups [1,2,3,4]
Testing availability in low-income and minority neighborhoods The shift from drive-through to walk-up sites increased the percentage of the persons tested who were residents of Orleans Parish from 45.8 to 78.5%, improving utilization by the intended beneficiaries
The walk-up sites partially succeeded in increasing availability of testing services in majority African American neighborhoods
Summary
In the months following the Covid-19 outbreak in the United States, hospitalization and mortality data clearly indicated that racial and ethnic minorities and socioeconomically deprived areas were bearing a higher burden of disease and death than other groups [1,2,3,4]. Evidence from New York City indicated that people living in working-class and minority neighborhoods were less likely to get tested than residents of white and wealthier areas [8], and similar concerns were raised regarding testing disparities between rural and urban dwellers in Florida [9], and among ethnic minorities in Seattle [4]. As most tests were performed at health facilities, this partially reflected wellestablished disparities in access to formal care for vulnerable populations [10]. This created dangerous blind spot in testing coverage, which blurred the true burden of disease and hindered early cluster detection, contact tracing and follow-up care in vulnerable communities. While most GIS work on Covid-19 testing coverage and access has used census tract or ZIP code aggregated data, this manuscript is unique in that it uses individual level demographics and exact addresses to calculate distances traveled by patients
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