Increasing access and uptake of SARS-CoV-2 at-home tests using a community-engaged approach.


Inequalities around COVID-19 testing and vaccination persist in the U.S. health system. We investigated whether a community-engaged approach could be used to distribute free, at-home, rapid SARS-CoV-2 tests to underserved populations. Between November 18-December 31, 2021, 400,000 tests were successfully distributed via 67 community partners and a mobile unit to a majority Hispanic/Latino/Spanish population in Merced County, California. Testing before gathering (59 %) was the most common testing reason. Asians versus Whites were more likely to test for COVID-19 if they had close contact with someone who may have been positive (odds ratio [OR] = 3.4, 95 % confidence interval [CI] = 1.7-6.7). Minors versus adults were more likely to test if they had close contact with someone who was confirmed positive (OR = 1.7, 95 % CI = 1.0-3.0), whereas Asian (OR = 4.1, 95 % CI = 1.2-13.7) and Hispanic/Latino/Spanish (OR = 2.5, 95 % CI = 1.0-6.6) versus White individuals were more likely to test if they had a positive household member. Asians versus Whites were more likely to receive a positive test result. Minors were less likely than adults to have been vaccinated (OR = 0.2, 95 % CI = 0.1-0.3). Among unvaccinated individuals, those who completed the survey in English versus Spanish indicated they were more likely to get vaccinated in the future (OR = 8.2, 95 % CI = 1.5-44.4). Asians versus Whites were less likely to prefer accessing oral COVID medications from a pharmacy/drug store only compared with a doctor's office or community setting (OR = 0.3, 95 % CI = 0.2-0.6). Study findings reinforce the need for replicable and scalable community-engaged strategies for reducing COVID-19 disparities by increasing SARS-CoV-2 test and vaccine access and uptake.





Published Version (Please cite this version)


Publication Info

D'Agostino, Emily M, Giselle Corbie, Warren A Kibbe, Christoph P Hornik, Al Richmond, Angella Dunston, Allyn Damman, Lisa Wruck, et al. (2022). Increasing access and uptake of SARS-CoV-2 at-home tests using a community-engaged approach. Preventive medicine reports, 29. p. 101967. 10.1016/j.pmedr.2022.101967 Retrieved from

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.



Emily Meredith D'Agostino

Assistant Professor in Orthopaedic Surgery

Emily D'Agostino, DrPH, MS, MEd, MA, is a community-engaged epidemiologist specializing in health disparities related to place. Her research expertise lies in partnering with community organizations to examine structural and social factors that reduce obesity disparities and promote physical activity and fitness. She also specializes in expanding epidemiology education to high school and undergraduate students, and incorporating contemporary teaching and learning practices into epidemiology instruction at all levels. She is currently an Assistant Professor at Duke University in Orthopaedic Surgery. She also provides research oversight for the Miami-Dade County Department of Parks, Recreation and Open Spaces, the third largest county park system in the nation, and New York City Department of Health and Mental Hygiene's NYC FITNESSGRAM co-managed by the New York City Department of Education. She received her doctorate in Epidemiology from the City University of New York's Graduate School of Public Health and Health Policy. She also holds master's degrees in Science Education, Educational Leadership, and Museum Education.


Warren Alden Kibbe

Professor in Biostatistics & Bioinformatics

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. 


Christoph Paul Vincent Hornik

Professor of Pediatrics

Lisa Wruck

Associate Professor of Biostatistics & Bioinformatics

Coordinating Centers, Pragmatic Clinical Research, Real World Evidence, Neurocognitive Data, Data Science Workforce Development 


Michael Cohen-Wolkowiez

Kiser-Arena Distinguished Professor

Pediatric and adult clinical pharmacology and clinical trials.

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.