RESPECT-UP grant looks at multiple factors surrounding COVID-19 testing in underserved communities

The COVID-19 pandemic shined a light on the disparities in health and health care access faced by underserved communities.The National Institutes of Health, through its Rapid Acceleration of Diagnostics in Underserved Populations, or RADx-UP, initiative, recently awarded Gabriela Oates, Ph.D., assistant professor in the University of Alabama at Birmingham Marnix E. Heersink School of Medicine, a $1.2 million grant to better understand the social, ethical and behavioral factors surrounding COVID-19 testing in vulnerable communities. 

The project, titled Reducing Ethical and Social Prejudicial Effects of COVID-19 Testing in Underserved Populations, or RESPECT-UP, will explore stigma, discrimination and other social factors that affect COVID-19 testing.

As a scientist at the UAB (MHRC), Oates will have access to a range of services, including a coalition of community partners with a long-standing history of collaboration. During the pandemic, the MHRC community engagement team has been connecting 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 disparities will likely continue. Unfortunately, public health strategies that are effective in stopping the spread of COVID-19 infection, such as targeted testing and contact tracing, can also be stigmatizing and may be particularly harmful when directed toward already marginalized groups.

“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 heath care, and avoid being tested,” said Janet Turan, Ph.D., professor at UAB’s School of Public Health and co-investigator. “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.” 

Gabriela Oates, Ph.D.,
Photography: Steve WoodRESPECT-UP’s approach could generate results that will be used for years to come.

“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, health care and community contexts,” Oates said. “For future outbreaks, this translates to delivering equitable, non-stigmatizing and non-discriminatory testing that meets community needs.”

Oates and her team will evaluate the toolkits in primary care settings.

“COVID-19 testing is complex. Lack of access to tests, concerns about the stigma of testing and fear of a COVID-19 diagnosis contribute to many people’s not being tested,” Oates said. “These barriers have a disproportionate effect on African Americans and those living in poverty. Primary care clinics play an enormous role as trusted and accessible sources of both information and testing.” 

UAB received one of eight grant awards given to institutions across the country. RESPECT-UP brings together a multidisciplinary team of UAB investigators including Raegan Durant, M.D.; Janet Turan, Ph.D.; Lori Bateman, Ph.D., R.D., and Mona Fouad, M.D.

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