Integrating Rapid Diabetes Screening Into a Latinx Focused Community-Based Low-Barrier COVID-19 Testing Program | Health Disparities | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

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
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.


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.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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 (

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.

Lopez  L  III , Hart  LH  III , Katz  MH .  Racial and ethnic health disparities related to COVID-19.   JAMA. 2021;325(8):719-720. doi:10.1001/jama.2020.26443PubMedGoogle ScholarCrossref
Tai  DBG , Sia  IG , Doubeni  CA , Wieland  ML .  Disproportionate impact of COVID-19 on racial and ethnic minority groups in the United States: a 2021 update.   J Racial Ethn Heal Disparities; 2021:1-6. doi:10.1007/s40615-021-01170-wGoogle ScholarCrossref
Michener  L , Aguilar-Gaxiola  S , Alberti  PM ,  et al.  Engaging with communities—lessons (re)learned from COVID-19.   Prev Chronic Dis. 2020;17:E65. doi:10.5888/pcd17.200250PubMedGoogle ScholarCrossref
McElfish  PA , Rowland  B , Porter  A ,  et al.  Use of community-based participatory research partnerships to reduce COVID-19 disparities among Marshallese Pacific Islander and Latino Communities—Benton and Washington Counties, Arkansas, April-December 2020.   Prev Chronic Dis. 2021;18:E91. doi:10.5888/pcd18.210124PubMedGoogle ScholarCrossref
Brewer  LC , Asiedu  GB , Jones  C ,  et al.  Emergency preparedness and risk communication among African American churches: leveraging a community-based participatory research partnership COVID-19 initiative.   Prev Chronic Dis. 2020;17:E158. doi:10.5888/pcd17.200408PubMedGoogle ScholarCrossref
Abdul-Mutakabbir  JC , Casey  S , Jews  V ,  et al.  A three-tiered approach to address barriers to COVID-19 vaccine delivery in the Black community.   Lancet Glob Health. 2021;9(6):e749-e750. doi:10.1016/S2214-109X(21)00099-1PubMedGoogle ScholarCrossref
Brewer  LC , Woods  C , Patel  A ,  et al; FAITH! Community Steering Committee COVID-19 Task Force.  Establishing a SARS-CoV-2 (COVID-19) drive-through collection site: a community-based participatory research partnership with a federally qualified health center.   Am J Public Health. 2021;111(4):658-662. doi:10.2105/AJPH.2020.306097PubMedGoogle ScholarCrossref
US Centers for Disease Control and Prevention. Summary Health Statistics: National Health Interview Survey: 2018. Table A-4a. Accessed December 15, 2021.
Desai  N , Lora  CM , Lash  JP , Ricardo  AC .  CKD and ESRD in US Hispanics.   Am J Kidney Dis. 2019;73(1):102-111. doi:10.1053/j.ajkd.2018.02.354PubMedGoogle ScholarCrossref
Varma  R , Choudhury  F , Klein  R , Chung  J , Torres  M , Azen  SP ; Los Angeles Latino Eye Study Group.  Four-year incidence and progression of diabetic retinopathy and macular edema: the Los Angeles Latino Eye Study.   Am J Ophthalmol. 2010;149(5):752-761. doi:10.1016/j.ajo.2009.11.014PubMedGoogle ScholarCrossref
US Centers for Disease Control and Prevention. National Vital Statistics Report, Vol. 69, No. 13. Table 10. Published January 12, 2021. Accessed December 15, 2021.
Cusi  K , Ocampo  GL .  Unmet needs in Hispanic/Latino patients with type 2 diabetes mellitus.   Am J Med. 2011;124(10)(suppl):S2-S9. doi:10.1016/j.amjmed.2011.07.017PubMedGoogle ScholarCrossref
Hu  R , Shi  L , Rane  S , Zhu  J , Chen  CC .  Insurance, racial/ethnic, SES-related disparities in quality of care among US adults with diabetes.   J Immigr Minor Health. 2014;16(4):565-575. doi:10.1007/s10903-013-9966-6PubMedGoogle ScholarCrossref
Doshi  M , Lopez  WD , Mesa  H ,  et al.  Barriers & facilitators to healthcare and social services among undocumented Latino(a)/Latinx immigrant clients: perspectives from frontline service providers in Southeast Michigan.   PLoS One. 2020;15(6):e0233839. doi:10.1371/journal.pone.0233839PubMedGoogle ScholarCrossref
Davidson  MB , Duran  P , Lee  ML .  Community screening for pre-diabetes and diabetes using HbA1c levels in high-risk African Americans and Latinos.   Ethn Dis. 2014;24(2):195-199.PubMedGoogle Scholar
Manusov  EG , Diego  VP , Smith  J ,  et al.  UniMóvil: a Mobile Health Clinic Providing Primary Care to the Colonias of the Rio Grande Valley, South Texas.   Front Public Health. 2019;7:215. doi:10.3389/fpubh.2019.00215PubMedGoogle ScholarCrossref
Millard  AV , Graham  MA , Mier  N ,  et al.  Diabetes screening and prevention in a high-risk, medically isolated border community.   Front Public Health. 2017;5:135. doi:10.3389/fpubh.2017.00135PubMedGoogle ScholarCrossref
Fields  J , Gutierrez  JR , Marquez  C , Rhoads  K , Kushel  M , Fernandez  A ,  et al.  Community-academic partnerships to address Covid-19 inequities: lessons from the San Francisco Bay Area.  NEJM Catal. Published online June 23, 2021. doi:10.1056/CAT.21.0135
US Census Bureau. Census Reporter Profile webpage for ZIP Code Tabulation Area 94110, San Francisco, CA. Updated 2020. Accessed May 21, 2021.
Marquez  C , Kerkhoff  AD , Naso  J ,  et al.  A multi-component, community-based strategy to facilitate COVID-19 vaccine uptake among Latinx populations: from theory to practice.   PLoS One. 2021;16(9):e0257111. doi:10.1371/journal.pone.0257111PubMedGoogle ScholarCrossref
Rubio  LA , Peng  J , Rojas  S ,  et al; CLIAHUB Consortium.  The COVID-19 symptom to isolation cascade in a Latinx community: a call to action.   Open Forum Infect Dis. 2021;8(2):ofab023. doi:10.1093/ofid/ofab023PubMedGoogle ScholarCrossref
Kerkhoff  AD , Sachdev  D , Mizany  S ,  et al.  Evaluation of a novel community-based COVID-19 ‘test-to-care’ model for low-income populations.   PLoS One. 2020;15(10):e0239400. doi:10.1371/journal.pone.0239400PubMedGoogle ScholarCrossref
Shelton  RC , Chambers  DA , Glasgow  RE .  An extension of RE-AIM to enhance sustainability: addressing dynamic context and promoting health equity over time.   Front Public Health. 2020;8:134. doi:10.3389/fpubh.2020.00134PubMedGoogle ScholarCrossref
American Diabetes Association.  2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2021.   Diabetes Care. 2021;44(suppl 1):S15-S33. doi:10.2337/dc21-S002PubMedGoogle ScholarCrossref
Weiner  BJ , Lewis  CC , Stanick  C ,  et al.  Psychometric assessment of three newly developed implementation outcome measures.   Implement Sci. 2017;12(1):108. doi:10.1186/s13012-017-0635-3PubMedGoogle ScholarCrossref
Graham  GN , Kim  S , James  B ,  et al.  Benefits of standardized diabetes and hypertension screening forms at community screening events.   Health Promot Pract. 2006;7(1):26-33. doi:10.1177/1524839905283890PubMedGoogle ScholarCrossref
Porterfield  DS , Din  R , Burroughs  A ,  et al.  Screening for diabetes in an African-American community: the Project DIRECT experience.   J Natl Med Assoc. 2004;96(10):1325-1331.PubMedGoogle Scholar
Grant  T , Soriano  Y , Marantz  PR ,  et al.  Community-based screening for cardiovascular disease and diabetes using HbA1c.   Am J Prev Med. 2004;26(4):271-275. doi:10.1016/j.amepre.2003.12.015PubMedGoogle ScholarCrossref
Willis  A , Roshan  M , Patel  N ,  et al.  A community faith centre based screening and educational intervention to reduce the risk of type 2 diabetes: a feasibility study.   Diabetes Res Clin Pract. 2016;120:73-80. doi:10.1016/j.diabres.2016.07.025PubMedGoogle ScholarCrossref
Misra  R , Fitch  C , Roberts  D , Wright  D .  Community-based diabetes screening and risk assessment in rural West Virginia.   J Diabetes Res. 2016;2016:2456518. doi:10.1155/2016/2456518PubMedGoogle ScholarCrossref
Tabaei  BP , Burke  R , Constance  A ,  et al.  Community-based screening for diabetes in Michigan.   Diabetes Care. 2003;26(3):668-670. doi:10.2337/diacare.26.3.668PubMedGoogle ScholarCrossref
Patel  K , Larson  C , Hargreaves  M ,  et al.  Community screening outcomes for diabetes, hypertension, and cholesterol: Nashville REACH 2010 project.   J Ambul Care Manage. 2010;33(2):155-162. doi:10.1097/JAC.0b013e3181dd4619PubMedGoogle ScholarCrossref
Snella  KA , Canales  AE , Irons  BK ,  et al.  Pharmacy- and community-based screenings for diabetes and cardiovascular conditions in high-risk individuals.   J Am Pharm Assoc (2003). 2006;46(3):370-377. doi:10.1331/154434506777069598PubMedGoogle ScholarCrossref
Ayorinde  AA , Porteous  T , Sharma  P .  Screening for major diseases in community pharmacies: a systematic review.   Int J Pharm Pract. 2013;21(6):349-361. doi:10.1111/ijpp.12041PubMedGoogle ScholarCrossref
Papastergiou  J , Rajan  A , Diamantouros  A , Zervas  J , Chow  J , Tolios  P .  HbA1c testing in the community pharmacy: a new strategy to improve care for patients with diabetes.   Can Pharm J (Ott). 2012;145(4):165-167. doi:10.3821/145.4.cpj165PubMedGoogle ScholarCrossref
Fiscella  K , Sanders  MR .  Racial and ethnic disparities in the quality of health care.   Annu Rev Public Health. 2016;37(1):375-394. doi:10.1146/annurev-publhealth-032315-021439PubMedGoogle ScholarCrossref
Oh  H , Trinh  MP , Vang  C , Becerra  D .  Addressing barriers to primary care access for Latinos in the U.S.: an agent-based model.   J Soc Social Work Res. 2020;11(2):165-184. doi:10.1086/708616Google ScholarCrossref
Osorio  M , Ravenell  JE , Sevick  MA ,  et al.  Community-based hemoglobin A1C testing in barbershops to identify Black men with undiagnosed diabetes.   JAMA Intern Med. 2020;180(4):596-597. doi:10.1001/jamainternmed.2019.6867PubMedGoogle ScholarCrossref
Joshi  A , Trout  K .  The role of health information kiosks in diverse settings: a systematic review.   Health Info Libr J. 2014;31(4):254-273. doi:10.1111/hir.12081PubMedGoogle ScholarCrossref
Abraham  O , Patel  M , Feathers  A .  Acceptability of health kiosks within African American community settings: a pilot study.   Health Serv Res Manag Epidemiol. 2018;5:2333392817752211. doi:10.1177/2333392817752211PubMedGoogle ScholarCrossref
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity



My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right