ABSTRACT
Background. The Baltimore City Health Department (BCHD) began community-based COVID-19 testing in response to the pandemic on April 21, 2020. The purpose was to provide access to COVID-19 testing to underserved communities. BCHD designed the program to accommodate transportation limitations, limited-access to internet and phones, and non-English speakers. BCHD has continued hosting up to five community-based testing sites per week. This analysis examines the test results of BCHD's COVID-19 community-based testing program to date. Methods. Patients completed an intake form, which included demographic information, at the testing event, prior to providing their specimen for COVID-19 testing. For this analysis, patient demographics and test results were analyzed using REDCap software. Results. Total test volume for year 2020 (4/21/2020 -12/30/2020) was 15,839, year 2021 (1/5/2021- 12/30/2021) was 13,087, and year 2022 (1/4/2022 - 4/1/2022) was 2,261. Average percent positivity for year 2020 was 9%, year 2021 was 7%, and year 2022 to date was 6%. Patient ethnicity was Non-Hispanic 85.5%, Hispanic 13.5%, and Did not respond/Don't know 1.0%. Race was Black or African America 61.1%, White 25.0%, Asian 2.8%, American Indian/Alaska Native 0.1%, Native Hawaiian or Other Pacific Islander 0.1%, and Unknown 10.7%. Total positive COVID-19 results among Black/African Americans in 2020, 2021, and 2022 respectively were 1567 (12.8%), 1177 (15.1%), and 218 (22.1%). Total positive COVID-19 results among White in 2020, 2021, and 2022 respectively were 541 (10.1%), 441 (12.1%), and 60 (15.1%) respectively. Total positive COVID-19 results among Asians in 2020, 2021, and 2022 were 63 (20.9%), 47 (11.0%), and 4 (25.5%) respectively. Total positive COVID-19 results among Native Hawaiian or Other Pacific Islander in 2020, 2021, and 2022 respectively were 4 (16.7%), 4 (20.0%), and 2 (0.0%) respectively. Total positive COVID-19 results among American Indian/Alaskan in 2020, 2021, and 2022 were 3 (13.6%), 1 (7.1%), and 2 (66.7%) respectively. Conclusion. BCHD's community-based testing program has completed over 31,000 tests to date. COVID-19 percent positivity among patients showed a decline across the three years. This analysis demonstrates how a local health department can provide testing to the communities.
ABSTRACT
Background: The impact of COVID-19 mitigation measures on STI transmission and racial disparities remains unknown. The objectives were to examine trends in sex and drug risk behaviors, access to sexual health services and STI positivity overall and by race during-compared to pre-pandemic among urban sexual minorities (MSM). Methods: Sexually-active MSM aged 18-45 years were administered a behavioral survey and STI testing at three-month intervals. Participants completing > one during-pandemic (April-December 2020) and one pre-pandemic study visit (before March 13, 2020) occurring < six months apart were included. Generalized estimating equations with modified Poisson regression models compared outcomes during-compared to pre-pandemic visits. Results: Among 231 MSM, reports of > three sex partners declined [adjusted Prevalence Ratio (aPR): pandemic-1(p1) 0.68, 95% CI (0.54-0.86);pandemic-2(p2) 0.65 (0.51-0.84);pandemic-3(p3) 0.57 (0.43-0.75)];similar findings were observed among Black and non-Black MSM. Black, but not non-Black MSM, reported sustained decreases in substance use (aPR: p1 0.90 (0.79-1.03);p2 0.74 (0.62-0.89);p3 0.82 (0.67-0.99)], and increased HIV/PrEP care engagement [aPR: p1 1.20 (1.07-1.34);p2 1.24 (1.11-1.39);p3 1.30 (1.16-1.47)]. Reported STI testing (overall and by race) decreased [aPR: p1 0.68 (0.57-0.81);p2 0.78 (0.67-0.92)], then rebounded [aPR: p3 1.01 (0.87-1.18)]. Overall, neither chlamydia [aPR: p2 1.62 (0.75-3.46);p3 1.13 (0.24-1.27)] nor gonorrhea [aPR: p2 0.87 (0.46-1.62) p3 0.56 (0.24-1.27)] positivity significantly changed during vs. pre-pandemic. Conclusion: We observed sustained decreases in STI risk behaviors but minimal change in STI positivity during compared to pre-pandemic. Findings underscore the urgent need for novel strategies to deliver STI prevention services without in-person interactions among MSM.
ABSTRACT
The COVID-19 pandemic left an unprecedented impact on the general public health, resulting in hundreds of thousands of deaths in the U.S. alone. Nationwide testing plans were initiated with drive-through being the currently dominant testing approach, which, however, exhausts personal protective equipment supplies, and is unfriendly to individuals not owning a vehicle. Walkup positive pressure testing booths are a safe alternative, whereby a health care provider situated on the inside of an enclosed and positively pressurized booth swabs a patient on the outside through chemical resistant gloves. The booths, however, are too prohibitively priced on the market to allow for nationwide deployment. To mitigate this, we present in this paper a safe, accessible, mobile, and affordable design of positive-pressure COVID-19 testing booths. The booths have successfully passed the Centers for Disease Control and Prevention and Health care Infection Control Practices Advisory Committee pressure, air exchange, and air quality requirements for positive-pressure rooms, following the guidelines for environmental infection control in health care facilities. The booths are manufactured using primarily off-the-shelf components from U.S. vendors with minimized customization, and the final bill of materials does not surpass USD 3,900. Since August 2019, five booths were deployed and used at the Johns Hopkins University School of Nursing, Baltimore City Health Department, and two community health centers in Baltimore. No health care provider was infected when using our booths, which have shown to facilitate walkup testing with decreased personal protective equipment consumption, reduced risk of infection, and enhanced accessibility to lower-income communities and nondrivers. Copyright © 2022 by ASME.