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RADx-UP: Bringing COVID Testing to our Underserved Urban Communities

March 30, 2022 by Ellen Brennan

Over the past two years, we’ve heard a lot about quarantines and vaccinations, but there’s a critical aspect of the pandemic response that doesn’t get its equal share of the spotlight: testing. To address this, the National Institutes of Health (NIH) launched the RADx program to support research that expands testing accessibility, and Dr. Kathleen Fairfield of MaineHealth was awarded RADx-UP funding for her project on providing testing to immigrant, low-income, and unhoused populations around Portland, Maine.

Over the past two years, we’ve heard a lot about quarantines and vaccinations, but there’s a critical aspect of the pandemic response that doesn’t get its equal share of the spotlight: testing. To address this, the National Institutes of Health (NIH) launched the RADx program to support research that expands testing accessibility.

“Rapid response. That’s what they [NIH] wanted; something fast regarding testing and any barriers to COVID testing.” ~ Yvonne Jonk

Since its launch in 2020, around 100 RADx projects across the country have been funded, including the development of different types of COVID test kits. More recently, our NNE-CTR members have received funding through this program for multiple projects focused not only on effective testing protocols, but how to get those tests to the underserved and vulnerable populations unique to our region.


While northern New England is a predominantly rural region, rural communities are not our only underserved populations. To meet the needs of some of our vulnerable, urban groups, Dr. Kathleen Fairfield of MaineHealth was awarded RADx-UP funding for her project on providing testing to immigrant, low-income, and unhoused populations around Portland, Maine.

“We have a diverse immigrant population from all over the world, and many of them are essential workers. They were out doing work during the early days of the pandemic. We also have a large unhoused community, and we have people who access care through public health services like at the Portland Community Free Clinic.” – Kathleen

In order to identify the barriers immigrant and unhoused populations face with getting access to COVID testing, Kathleen and her team leveraged the expertise of community programs that were already providing important services for these specific groups. They set up interviews with people who worked for these programs, as well as with individuals from each of the populations of interest to pinpoint exactly what challenges they faced with regards to testing. “One of the really fascinating things about this project is that the community partners are making a lot of key observations and sharing them with our research team,” says Kathleen. “They understood many of the reasons why patients would be frightened or reluctant to get tested.” From these interviews, the study team was able to identify some of the major barriers and hesitations regarding testing so they could start coming up with solutions.

“Some of the immigrant populations have jobs without sick pay, so even if they had access to tests, they may not want to get tested because it means they would lose income. In the early days, testing included a deep nasal swab. That was very frightening to some people. And with most testing centers, people have to schedule online, and for unhoused or non-English speakers, that’s very difficult.” – Kathleen

There was also the question of what happens when you test positive? For many, that means losing work. It also could mean struggling to find safe housing for those with higher risk in their multi-generational homes. For the unhoused population, testing positive could mean being removed from the shelter which may be where all of their friends and supports are. After being removed from the shelter, individuals could go to a quarantine hotel but were unclear what that meant, so this also became frightening. “In the beginning, it felt like they did not have a choice,” Kathleen explains. “They were brought there, and they didn’t know they could leave or how it would impact access to services.”

Kathleen and her team have conducted dozens of interviews and are running problem and solution workshops to begin addressing these identified barriers. It’s at this stage where yet again, their community partnerships are helping the project thrive. Several low-barrier walk-up clinics are held each week in Portland, and other programs have already launched to provide equitable access to COVID testing. Kathleen says it’s the community leaders who are helping to make this happen.

“We set up these walk-up clinics in places that are familiar, and having one of our community partners be there to assist the clinic and answer questions is really great. If a client is unhoused, they know [Partner] and they see [Partner], and they’re less scared.” – Kathleen

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