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Integrating Rapid Diabetes Screening Into a Latinx Focused Community-Based Low-Barrier COVID-19 Testing Program

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
JAMA Network Open
May 26, 2022
Original Investigation
Andrew D. Kerkhoff, MD, PhD1;
Susana Rojas2;
Douglas Black, BA1;
Salustiano Ribeiro, MS3;
Susy Rojas, BS4;
Rebecca Valencia, BSN4;
Jonathan Lemus, BA4;
Joselin Payan4;
John Schrom, MPH1;
Diane Jones, RN4;
Simone Manganelli, MS4;
Shalom Bandi, BASc;
Gabriel Chamie, MD1;
Valerie Tulier-Laiwa, JD2;
Maya Petersen, MD, PhD5;
Diane Havlir, MD1;
Carina Marquez, MD, MPH1
Author Affiliations
  • 1Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
  • 2San Francisco Latino Task Force–Response to COVID-19, San Francisco, California
  • 3Bay Area Phlebotomy and Laboratory Services, San Francisco, California
  • 4Unidos en Salud, San Francisco, California
  • 5Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley
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Key Points

Question  Is integrating rapid diabetes screening into a community-based COVID-19 testing site feasible and effective in reaching socioeconomically disadvantaged Latinx persons without health care?

Findings  In this health care improvement study of 6631 participants presenting for COVID-19 testing, 923 (13.9%) underwent hemoglobin A1c testing, of which 313 (34%) and 113 (12%) had prediabetes and diabetes, respectively. Persons reached were mostly Latinx (83%), low-income, had not previously been tested for diabetes, and were not engaged in formal health care services.

Meaning  These results suggest that leveraging community COVID-19 infrastructure and partnerships has the potential to address disparities in diabetes.

Abstract

Importance  Community-based COVID-19 testing and vaccination programs play a crucial role in mitigating racial and ethnic disparities in COVID-19 service delivery. They also represent a platform that can be leveraged to expand access to testing for chronic diseases, including diabetes, that disproportionately affect the Latinx community and other marginalized communities.

Objective  To evaluate outcomes associated with a diabetes testing strategy designed to reach low-income Latinx persons by leveraging COVID-19 testing infrastructure and community trust developed during the COVID-19 pandemic.

Design, Setting, and Participants  This health care improvement study was conducted from August 1 to October 5, 2021, at an outdoor, community-based COVID-19 testing site at a transport hub in the Mission Neighborhood in San Francisco, California. Because the program was designed to expand access to diabetes screening to the local community, all individuals presenting for on-site testing were eligible. Data were analyzed in November 2021.

Interventions  Integration of rapid, point-of-care hemoglobin A1c screening as a testing option in an existing low-barrier COVID-19 testing program.

Main Outcomes and Measures  Evaluation was guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and utilized programmatic data and structured surveys among clients and staff.

Results  Of 6631 individuals tested (median [IQR] age 39.3 [29.7-51.3] years; 3417 [52.3%] female, 4348 [65.6%] Latinx), 923 (13.9%) underwent hemoglobin A1c testing with or without COVID-19 testing and 5708 (86.1%) underwent COVID-19 testing only. Individuals tested for diabetes were more likely to be Latinx (763 of 923 individuals [82.7%] who underwent testing were Latinx vs 3585 of 5708 [62.8%] not undergoing testing), have an annual household income of less than $50 000 (450 individuals [81.2%] vs 2409 individuals [66.0%]), and not have health insurance (381 individuals [47.2%] vs 1858 individuals [39.9%]), and 206 (48.0%) had never tested for diabetes before. Overall, 313 (33.9%) and 113 (12.2%) individuals had prediabetes and diabetes, respectively; only 141 of 354 of these individuals (39.8%) had a primary care clinician whom they had seen in the prior 12 months, which was lower among Latinx individuals (113 of 307 individuals [36.8%] vs 28 of 47 [59.6%]). Acceptability of the rapid testing program was high—98% were satisfied with their visit and 96% said they would return for future services; key factors underpinning acceptability included friendly staff, efficiency, and a convenient location.

Conclusions and Relevance  In this health care improvement study conducted within an existing community-based COVID-19 testing program, integrating rapid testing for diabetes was feasible, reached low-income Latinx individuals, and identified many persons with prediabetes and diabetes, most of whom lacked access to services in formal health care settings. Leveraging pandemic-related public health responses represents an important opportunity for engaging socioeconomically disadvantaged populations into care for diabetes.

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Health Disparities Diabetes Public Health Diabetes and Endocrinology Health Policy Coronavirus (COVID-19) Health Inequities Diversity, Equity, and Inclusion
Article Information

Accepted for Publication: March 20, 2022.

Published: May 26, 2022. doi:10.1001/jamanetworkopen.2022.14163

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Kerkhoff AD et al. JAMA Network Open.

Corresponding Author: Carina Marquez, MD, MPH, Division of HIV, Infectious Diseases Global Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, 995 Potrero Ave, San Francisco, CA 94110 (carina.marquez@ucsf.edu).

Author Contributions: Drs Kerkhoff and Marquez had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kerkhoff, Susana Rojas, Ribeiro, Jones, Tulier-Laiwa, Petersen, Havlir, Marquez.

Acquisition, analysis, or interpretation of data: Kerkhoff, Black, Susy Rojas, Valencia, Lemus, Payan, Schrom, Jones, Manganelli, Bandi, Chamie, Petersen, Havlir, Marquez.

Drafting of the manuscript: Kerkhoff, Schrom, Havlir, Marquez.

Critical revision of the manuscript for important intellectual content: Kerkhoff, Susana Rojas, Black, Ribeiro, Susy Rojas, Valencia, Lemus, Payan, Jones, Manganelli, Bandi, Chamie, Tulier-Laiwa, Petersen, Havlir, Marquez.

Statistical analysis: Kerkhoff, Petersen.

Obtained funding: Havlir.

Administrative, technical, or material support: Black, Ribeiro, Susy Rojas, Valencia, Lemus, Schrom, Jones, Manganelli, Bandi, Chamie, Havlir.

Supervision: Ribeiro, Payan, Havlir, Marquez.

Conflict of Interest Disclosures: Mr Manganelli reported receiving hourly wages from BayPLS for registration and check-out services at the multidisease testing site, both during the conduct of the study and outside the submitted work. Dr Chamie reported receiving grants from National Institutes of Health outside the submitted work. Dr Havlir reported receiving a supply of COVID-19 tests from Abbvie outside the submitted work. No other disclosures were reported.

Funding/Support: This program was supported by the University of California, San Francisco, John P. McGovern Foundation, and the Chan Zuckerberg Health Initiative.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We gratefully acknowledge Xzalyn Hernandez, BA, and Erica Vazquez, BA, from the Latino Task Force for COVID-19 for their contributions to health education and linkage to care. We would like to thank Joanna Eveland, MD, and Ricardo Duarte, RN, from San Francisco General Hospital for their contributions to health care linkage; and Bessa Makoni, NP, and Audrey Tang, NP, from Zuckerberg San Francisco General Hospital for their contributions in training community health workers on diabetes and lifestyle modifications. None of these individuals received any form of compensation for their support of or participation in this initiative.

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