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.

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.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.3389/fpubh.2023.1237066

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.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Tsalik

Ephraim Tsalik

Adjunct Associate Professor in the Department of Medicine

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. 

Taylor

Donald H. Taylor

Professor in the Sanford School of Public Policy

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).

Neighbors

Coralei Neighbors

Student

Coralei Neighbors is a second-year Ph.D. candidate in Population Health Sciences at Duke University School of Medicine. Her research focuses on the intersection of infectious diseases, health economics, and global health policy. With a strong foundation in epidemiology and disease surveillance, gained through a Bachelor of Science from Baylor University and a Master of Science in Global Health from Duke University, Coralei has experience in tackling global health challenges through a dual lens of scientific inquiry and policy analysis.

Her research encompasses infectious disease surveillance, economic modeling, and policy evaluation. With experience in both national and international settings, she is currently contributing to infectious disease surveillance initiatives and developing models to assess the economic impact and sustainability of vaccines and other health interventions in diverse populations. Coralei's work aims to inform the development of evidence-based policies to improve global health outcomes.


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