This Test-to-Care Model (T2C) was developed and evaluated by a research team from the University of California San Francisco (UCSF) in conjunction with local community members to provide a culturally-tailored and longitudinal form of support for low-income individuals who tested positive for COVID-19 and their households.
University of California San Francisco
- Academic Hospital
- Electronic medical record
- Text messaging
Team Members Involved
- Community Health Worker
- Primary Care Physicians
- Social Worker
- From April 27 to May 14, UCSF researchers and the Latino Task Force for COVID-19 demonstrated their co-designed T2C model in the Mission district of San Francisco. As a part of their Unidos en Salud study, a team of community healthcare workers and healthcare providers assisted Latinx individuals who agreed to receive support after testing positive for COVID-19.
- Over the course of the two weeks after diagnosis, T2C team members reached out to participants through texts, phone calls, and home deliveries. The team provided 1) medical needs assessments 2) social work support and advice and 3) material resources (including food, PPE, cleaning supplies, and exit packages).
- To continue to support households beyond the two week period, the T2C team connected participants with primary care providers, helped to enroll people into health insurance, and offered testing for close contacts of those affected.
- The authors also evaluated the model for its Reach, Effectiveness, Adoption, Implementation, and Maintenance (or the RE-AIM framework) by examining informal interviews with community health workers and participants, programmatic data, and surveys.
- 83 participants (of a survey of 3,874 residents) tested positive for COVID-19. The T2C team was able to reach 80/83.
- 95% of participants were Latinx and 83% reported Spanish as their preferred language. 88% had an annual household income <50,000, 55% were not connected with a primary care provider, and 45% were uninsured.
- Overall, participants reported the intervention “highly acceptable” and that the team’s social, emotional, and material provisions through check-ins and home deliveries provided them valuable support. Furthermore, participants communicated that their trust increased, resulting in nine individuals reporting larger household sizes than initially reported and six individuals requesting hotel relocation services after initially declining them.
- 60 participants (75% of those contacted) requested the help of the T2C team. The multicultural and bilingual team continually assessed and responded to the needs of the households, building the trust of the participants. The three full-time community health workers and five part-time providers logged 250 daily phone calls, 105 home deliveries, and 300 bags of groceries. Three participants were referred to the emergency room or urgent care for assessment, one participant was hospitalized, and none died.
- A month after the project, four more of the 36 uninsured individuals had health insurance, and three more participants had a primary care provider. No participants reported unintended harm or discrimination from the interaction.
- Providers and community healthcare workers reported the T2C model would likely be possible to implement and sustain in other settings, tailored to other vulnerable populations. They also emphasized the importance of daily huddles to avoid inefficiencies.
- Although significant time and resource investment facilitated the success of this model, some healthcare workers reported the T2C Model activities were not easy to carry out.
- Evaluation of the project was limited to informal interviews and did not directly determine whether the T2C Model increased adherence to quarantine mandates.
- Initially, community health workers and care providers reported some participants were confused by other contact tracing services contacting the same household with similar questions. Although it posed no major issues, the authors noted that full integration and consideration of these organizations would be beneficial for community members.
- Although the team who implemented it believes it could be easily adapted to fit other settings, the T2C Model may not be generalizable because it was designed specifically for the residents of the Mission District in San Francisco.
- The authors reported outreach challenges in reaching household members as well as individuals who tested positive for COVID-19 and declined support for unclear reasons. Further research is needed to estimate the effect of this model on close contacts and household members.
- Kerkhoff, A. D., Sachdev, D., Mizany, S., Rojas, S., Gandhi, M., Peng, J., … & Tulier-Laiwa, V. (2020). Evaluation of a novel community-based COVID-19 ‘Test-to-Care’model for low-income populations. PloS one, 15(10), e0239400.
- Andrew Kerkhoff, MD, PhD
- Jaya Gatchell, BA
San Francisco, CaliforniaTalk to the Innovators