Access to COVID-19 testing by individuals with housing insecurity during the early days of the COVID-19 pandemic in the United States: a scoping review.
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2023-01
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Abstract
Introduction
The COVID-19 pandemic focused attention on healthcare disparities and inequities faced by individuals within marginalized and structurally disadvantaged groups in the United States. These individuals bore the heaviest burden across this pandemic as they faced increased risk of infection and difficulty in accessing testing and medical care. Individuals experiencing housing insecurity are a particularly vulnerable population given the additional barriers they face. In this scoping review, we identify some of the barriers this high-risk group experienced during the early days of the pandemic and assess novel solutions to overcome these barriers.Methods
A scoping review was performed following PRISMA-Sc guidelines looking for studies focusing on COVID-19 testing among individuals experiencing housing insecurity. Barriers as well as solutions to barriers were identified as applicable and summarized using qualitative methods, highlighting particular ways that proved effective in facilitating access to testing access and delivery.Results
Ultimately, 42 studies were included in the scoping review, with 143 barriers grouped into four categories: lack of cultural understanding, systemic racism, and stigma; medical care cost, insurance, and logistics; immigration policies, language, and fear of deportation; and other. Out of these 42 studies, 30 of these studies also suggested solutions to address them.Conclusion
A paucity of studies have analyzed COVID-19 testing barriers among those experiencing housing insecurity, and this is even more pronounced in terms of solutions to address those barriers. Expanding resources and supporting investigators within this space is necessary to ensure equitable healthcare delivery.Type
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Publication Info
Johannesson, Jon M, William A Glover, Cathy A Petti, Timothy H Veldman, Ephraim L Tsalik, Donald H Taylor, Stephanie Hendren, Coralei E Neighbors, et al. (2023). Access to COVID-19 testing by individuals with housing insecurity during the early days of the COVID-19 pandemic in the United States: a scoping review. Frontiers in public health, 11. p. 1237066. 10.3389/fpubh.2023.1237066 Retrieved from https://hdl.handle.net/10161/29286.
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Scholars@Duke
Ephraim Tsalik
My research at Duke has focused on understanding the dynamic between host and pathogen so as to discover and develop host-response markers that can diagnose and predict health and disease. This new and evolving approach to diagnosing illness has the potential to significantly impact individual as well as public health considering the rise of antibiotic resistance.
With any potential infectious disease diagnosis, it is difficult, if not impossible, to determine at the time of presentation what the underlying cause of illness is. For example, acute respiratory illness is among the most frequent reasons for patients to seek care. These symptoms, such as cough, sore throat, and fever may be due to a bacterial infection, viral infection, both, or a non-infectious condition such as asthma or allergies. Given the difficulties in making the diagnosis, most patients are inappropriately given antibacterials. However, each of these etiologies (bacteria, virus, or something else entirely) leaves a fingerprint embedded in the host’s response. We are very interested in finding those fingerprints and exploiting them to generate new approaches to understand, diagnose, and manage disease.
These principles also apply to sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Just as with acute respiratory illness, it is often difficult to identify whether infection is responsible for a patient’s critical illness. We have embarked on a number of research programs that aim to better identify sepsis; define sepsis subtypes that can be used to guide future clinical research; and to better predict sepsis outcomes. These efforts have focused on many systems biology modalities including transcriptomics, miRNA, metabolomics, and proteomics. Consequently, our Data Science team has utilized these highly complex data to develop new statistical methods, furthering both the clinical and statistical research communities.
These examples are just a small sampling of the breadth of research Dr. Tsalik and his colleagues have conducted.
In April 2022, Dr. Tsalik has joined Danaher Diagnostics as the VP and Chief Scientific Officer for Infectious Disease, where he is applying this experience in biomarkers and diagnostics to shape the future of diagnostics in ID.
Donald H. Taylor
Don Taylor is a health policy scholar who has studied rural health, identification of underserved areas, and the economics of smoking and cessation. For the past 20 years his work has focused on how society cares for the elderly and to what effect on individuals, families, public programs and inter-generational wealth. More recently he has focused on archival research methods that help to illustrate the role of Race in our history—individual, institutional, national. An emerging interest is consideration of how visual art and fiction might be more effective at making inequality of various types unacceptable culturally in a way that is more effective than data based and more traditional public policy-based appeals. All three of his degrees (Ph.D., Public Health, Health Policy and Management, 1995) are from the University of North Carolina at Chapel Hill. Taylor serves as the Director of the Social Science Research Institute (since 2019) and served two years as the elected leader of the Duke Faculty in the role of the Chair of the Academic Council (2017-19).
Steph Hendren
Steph is a Research and Education Librarian and liaison to the Doctor of Physical Therapy (DPT) and Occupational Therapy Doctorate (OTD) programs. She develops and teaches classes, conducts systematic reviews, and is engaged in research support and project consultations.
- MLIS, Library & Information Studies, University of Wisconsin Madison
- BA, English Literature, University of Wisconsin Madison
Coralei Neighbors
Coralei Neighbors, MS, is a third-year Ph.D. candidate in Population Health Sciences at the Duke University School of Medicine. Her research integrates infectious disease surveillance, economic evaluation, and policy analysis to inform evidence-based and equitable vaccine strategies. Her work sits at the intersection of infectious disease epidemiology, health economics, and global health policy, applying decision-analytic modeling and surveillance data to support population-level decision-making and resource allocation.
Coralei holds a Bachelor of Science in Health Science Studies from Baylor University and a Master of Science in Global Health from Duke University. She is currently pursuing graduate certificates in East Asian Studies, International Development Policy, and College Teaching, enhancing the global relevance and instructional impact of her work.
Her research contributes to advancing approaches that translate economic and epidemiologic evidence into actionable policy insights. She aims to support policymakers in developing effective, sustainable, and equity-driven immunization strategies. Long term, she aspires to contribute to global health systems strengthening through economic evaluation, decision-analytic modeling, and policy engagement.
Gayani Tillekeratne
Global health
Antimicrobial resistance/ stewardship
Acute respiratory tract infections
Emerging infections/ dengue
Warren Alden Kibbe
Warren A. Kibbe, PhD, is chief for Translational Biomedical Informatics in the Department of Biostatistics and Bioinformatics and Chief Data Officer for the Duke Cancer Institute. He joined the Duke University School of Medicine in August after serving as the acting deputy director of the National Cancer Institute (NCI) and director of the NCI’s Center for Biomedical Informatics and Information Technology where he oversaw 60 federal employees and more than 600 contractors, and served as an acting Deputy Director for NCI. As an acting Deputy Director, Dr. Kibbe was involved in the myriad of activities that NCI oversees as a research organization, as a convening body for cancer research, and as a major funder of cancer research, funding nearly $4B US annually in cancer research throughout the United States.
Michael Cohen-Wolkowiez
Pediatric and adult clinical pharmacology and clinical trials.
Christopher Wildrick Woods
1. Emerging Infections
2. Global Health
3. Epidemiology of infectious diseases
4. Clinical microbiology and diagnostics
5. Bioterrorism Preparedness
6. Surveillance for communicable diseases
7. Antimicrobial resistance
Mark Jae Lee
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