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Implementing testing approaches for SARS-CoV-2 to address health disparities: lessons learned from sexually transmitted infections
  1. Christina T Chu1,
  2. Brooke G Rogers1,
  3. Michaela A Maynard1,
  4. Siena C Napoleon1,
  5. Philip A Chan1,2
  1. 1 Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  2. 2 Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
  1. Correspondence to Dr Philip A Chan, Medicine, Brown University Warren Alpert Medical School, Providence, RI 02912, USA; Philip_Chan{at}

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SARS-CoV-2 is a novel coronavirus and the cause of COVID-19 ( There are currently 45 million individuals diagnosed with COVID-19 and over 1.2 million who have died worldwide.1 Of these, nine million cases and over 228 000 deaths have occurred in the USA.1 COVID-19 has disproportionately impacted individuals with comorbidities and of older age. Other social risk factors predicting vulnerability to COVID-19 include low socioeconomic status, race/ethnicity and occupational setting. There has been a higher number of COVID-19 cases and deaths among marginalised groups. Populations in the USA with a greater COVID-19 burden include African American/black and Hispanic/Latino communities. There are limited data on SARS-CoV-2 and sexual orientation and gender diversity. However, based on existing health disparities, the lesbian, gay, bisexual, transgender and queer (LGBTQ+) community is also likely to be disproportionately impacted by COVID-19. A key component of addressing COVID-19 is diagnostic testing for SARS-CoV-2. However, approaches and models to implementing accessible SARS-CoV-2 testing, especially for vulnerable communities, have not been well described.

STIs also disproportionately affect underserved and marginalised communities, with 376 million new infections of curable STIs worldwide in 2016.2 In the USA, African American/black, Hispanic/Latino and LGBTQ+ individuals are at a greater risk for STIs due to proximal and distal social determinants of health, including economic stability, physical environments, social and community context, education, and healthcare access.3 Similarly, the impact of social determinants has worsened STI health outcomes among vulnerable populations across the world.3 Given the overlap in communities affected by COVID-19 and STIs, there are significant lessons to be learned from experiences with STI testing. We examine challenges related to COVID-19 testing and offer potential solutions derived from STI testing that may increase access for those most at risk and mitigate health disparities (figure 1).

Figure 1

Improving access to COVID-19 testing.

SARS-CoV-2 testing and containment

The ability to …

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  • Handling editor Tristan J Barber

  • Contributors PAC conceived the idea for the paper. CTC, BGR, MAM, SCN and PAC contributed to writing the early drafts of the paper. BGR, MAM and SCN reviewed the manuscript drafts and provided feedback. CTC designed the figure. PAC and CTC prepared the final manuscript with contributions from all coauthors. All authors contributed to and have approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.