Reducing Ethical and Social Prejudicial Effects of COVID-19 Testing in Underserved Populations 

The COVID-19 pandemic highlighted the disparities in health and healthcare access faced by underserved communities. The National Institutes of Health (NIH), through its Rapid Acceleration of Diagnostics in Underserved Populations (RADx-UP) initiative, recently awarded eight national grants to understand better social, ethical, and behavioral factors surrounding COVID-19 testing in vulnerable communities. Gabriela Oates, Ph.D., assistant professor in the UAB Heersink School of Medicine Department of Pediatrics, Division of Pulmonary & Sleep Medicine, received one of those eight. 

Gabriela Oates,
Assistant Professor
in the Division of Pediatric Pulmonary & Sleep Medicine,
Ph.D.The $1.2-million project, Reducing Ethical and Social Prejudicial Effects of COVID-19 Testing in Underserved Populations (RESPECT-UP), will explore stigma, discrimination, and other social factors that affect COVID-19 testing. RESPECT-UP brings together a multidisciplinary team of UAB investigators, including Raegan Durant, MD, MPH; Janet Turan, Ph.D., MPH; Lori Bateman, Ph.D., RD; and Mona Fouad, MD, MPH.

As a scientist at the UAB Minority Health & Health Equity Research Center (MHERC), Oates will have access to an umbrella of services, including a coalition of community partners with a long-standing history of collaboration. During the pandemic, the MHRC community engagement team connected UAB investigators with Alabama communities to conduct surveys, focus groups, and assessments.

Earlier epidemiologic research by Oates and colleagues documented stark racial and socioeconomic disparities in COVID-19 testing, positivity, and case prevalence in Alabama. Without a strategy to mitigate such shortfalls, COVID-19 inequality will likely continue. Unfortunately, public health strategies that effectively stop the spread of COVID-19 infection, such as targeted testing and contact tracing, can also be stigmatizing and particularly harmful when directed toward already marginalized groups.

Janet Turan, Ph.D., MPH, an investigator working with Oates, explains, “We know from other viral outbreaks and epidemics globally, that fears of stigma and discrimination can drive people to deny or hide their illness, delay seeking health care, and avoid being tested.” She adds, “We need to understand the extent to which similar attitudes may be at play in the current pandemic if we want to reduce the disparities in COVID-19 morbidity and mortality.”

RESPECT-UP’s approach could generate results that will be used for years to come. Oates explains, “Our findings will allow us to develop actionable strategies to reduce inequities in COVID-19 testing. We will produce RESPECT-UP Toolkits tailored to various organizational, healthcare, and community contexts. This translates to delivering equitable, non-stigmatizing, and non-discriminatory testing that meets community needs for future outbreaks.” Oates and her team will evaluate the toolkits in primary care settings. Raegan Durant, MD, MPH, principal investigator for RESPECT-UP alongside Oates, notes, “COVID-19 testing is complex. Lack of access to tests, concerns about the stigma of testing, or fear of COVID-19 diagnosis contribute to many people not being tested. These barriers disproportionately affect African Americans and those living in poverty. Primary care clinics play an enormous role as trusted and accessible sources of both information and testing.”

RESPECT-UP is the third RADx-UP grant awarded to UAB, following earlier projects by Michael Mugavero, MD, MHSc, and Mona Fouad, MD, MPH.