Spotlight on the Safety Net: Deploying Mobile COVID-19 Testing Programs in North Carolina as an Approach to Improving Health Equity

Site Selection Process and Locations

The programs described here reached more than 13 North Carolina counties. Each program brought testing to underserved communities, and venues for testing were selected with community partners. Testing sites included churches, community centers, food processing plants, homeless services agencies, shopping centers, and farms. The UNC Rex Health mobile unit established a Community Advisory Board (CAB) from organizations serving Black and Latinx individuals to assist with selecting sites in Southeast Raleigh. NeighborHealth Center partnered with existing community agencies (churches, Urban Ministries, and Raleigh Rescue Mission) to aide in site selection, using state data to identify areas in Wake County with high poverty rates among Black and Latinx individuals.

Novant Health, Cone Health, and Atrium Health relied most on data-driven approaches. Atrium Health reviewed geographic information system (GIS) data weekly to identify emerging COVID-19 hotspots in underserved communities of color to pinpoint where testing was most needed and deployed a unit to these sites. Novant Health mined internal and public health data to identify zip codes with higher COVID-19 diagnosis rates, as well as higher COVID-19 mortality. Through this approach, Novant leveraged existing clinic locations in those communities, bringing the mobile testing unit to those sites. Cone Health’s Enterprise Analytics updated a map daily with information on testing rates, COVID-19 prevalence, and social vulnerability by census block group, allowing for a tight and timely focus on specific communities.

Cone Health has also completed on-site COVID-19 testing at homeless shelters and hotels in which the City of Greensboro provided rooms for those who could not safely stay in shelters. These mobile sites had low positivity rates. Regular testing allowed leaders to know they were performing the correct infection prevention procedures to ensure the ongoing safety of this vulnerable population.

The UNC School of Medicine Health on Wheels mobile van worked with partners at Piedmont Health, a large community health center network, departments of health (Chatham, Lee, and Nash), employers, and the state Department of Health and Human Services (NCDHHS) to identify locations with substantial mismatches in rates of testing and COVID-19 diagnoses, including at meat processing plants and farms with large communities of Latinx workers.

Advertising to Local Communities

Each program partnered with community stakeholders to develop strategies for disseminating messaging about the availability of COVID-19 testing. With the different approaches, community organizations—such as churches and local minority-owned media outlets—used their social media channels and community networks for word-of-mouth sharing about these events. Novant partnered with recording artists Doug E. Fresh and Anthony Hamilton to amplify key messages to underserved communities and reached out to the Latinx community through a Spanish language helpline and an online COVID-19 assessment tool that connected those in need to mobile testing sites and options. UNC Health and NeighborHealth leveraged their community partners’ social media sites and communications channels. Atrium Health established a task force to provide culturally responsive communications to minority communities, engaged with leaders from minority media outlets and clergy leaders, and launched specific initiatives to further engage with Latinx communities on how to stay safe and healthy.

Wraparound Services

All sites offered services such as interpreters to facilitate whole-person care and screenings for social drivers of health such as food insecurity. Several offered coordination with community services referrals for identified needs, including resources for food and housing insecurities and behavioral health. All programs worked closely with local health departments to ensure that those who tested positive were contacted for case investigation and contact tracing. Several also established a medical home for all who were tested either at their institution or a partner clinic.