JMIR Publications

ABSTRACT

Background:

Rural underserved areas facing health disparities have unequal access to health resources. By the third and fourth waves of SARS-CoV-2 infections in the United States, COVID-19 testing has reduced with more reliance on home testing, and those seeking testing are largely symptomatic.

Objective:

This study identifies factors associated with COVID-19 testing among symptomatic versus asymptomatic individuals seen at Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) testing sites in West Virginia.

Methods:

Demographic, clinical, and behavioral factors were collected via survey from individuals tested. Logistic regression was used to identify factors associated with presence of symptomatic individuals seen at testing sites. Global tests for spatial autocorrelation were conducted to examine clustering in the proportion of symptomatic to total individuals tested by zip code. Bivariate maps were created to display geographic distributions between higher proportion of symptomatic individuals tested and social determinants of health.

Results:

Among predictors, being 18 years or younger (aOR = 2.06, 95% CI = 1.01-4.32), having the presence of a physical (aOR = 1.90, 95% CI = 1.27-2.84) or mental (aOR = 1.89, 95% CI = 1.13-3.25) comorbid condition, no healthcare challenges (aOR = 0.15, 95% CI = 0.09-0.25), and community socio economic distress (aOR = 0.98, 95% CI = 0.97-0.99) were statistically associated with an individual being symptomatic at first test visit.

Conclusions:

This study addresses critical limitations to current COVID testing literature, which almost exclusively has utilized population level disease screening data to inform public health response.