A federal pilot program, “Say Yes to Covid Test”,  funded by the National Institute for Health (NIH), selected two sites in the United States this past March to distribute free at-home COVID-19 test kits as part of a study to see how Covid-19 home rapid testing affects the spread of this particular coronavirus. Federal officials want to examine the impact of in-home testing access and how it could impact the future of fighting and tracking COVID-19 in the United States. Ultimately, it’s to see if home testing affects people’s behaviors and slows transmission by comparing rates of transmission in Pitt County, North Carolina and Chattanooga, Tennessee to communities that do not have those kits.

The sites represent the entire United States. Pitt County, working in partnership with Duke University and University of North Carolina researchers, was selected because the poverty level there is two times higher than the national average and where access to regular testing was challenging for many of its citizens. With a total population of approximately 180,000 (Blacks 34.5% or approximately 61.2%) , many of its Black citizens did not have convenient testing sites available, which appears to be a phenomena for diverse neighborhoods throughout the country. Nonetheless, Pitt County’s pilot was open to anyone who desired to be included regardless of race, gender, sexual orientation, ethnicity, and religion.

When the project was launched this past Easter Sunday, the technology to do in-home testing had just been developed. Nationwide, more than 50,000 people per day were testing positive through standard testing and only 20% of Pitt County’s population had been vaccinated. The expectation was that the kits would be in high demand throughout the county.

Pitt County was notified of its selection by a Raleigh, North Carolina NIH representative who informed them that they had already done the research and would they convene a five-to-seven-member focus group to assess having the project there.

In preparation and to manage the initiative, Mildred Council, MSW and

Community Organizer/Advocate/Spokesperson, who initially had been contacted by Raleigh, began the process of contacting potential focus group members. The group was established as follows:

• Commissioner of Pitt County Board of Commissioners Ann Floyd Huggins, Chair, initiative spokesperson and contact for Sycamore Hill Missionary Baptist Church-Distribution Site;
• Council member Veronica Roberson, Town of Winterville, NC & Coordinator for three Municipalities: Winterville, Ayden and Grifton, NC;
• Valerie Gatlin Walker, MSN, RN, NE-BC Health Coach, appointed by Commissioner Brenda Hawkins, Town of Simpson to represent both the Village of Simpson with Philippi Missionary Baptist Church, Simpson-A Distribution Site;
• William T. Atkinson, Pasico Norfleet American Legion Post 160-Targets Veterans & Families & Community at Large, partners with 100 Black Men Organization;
• Minerva Freeman, Representing Commissioner James Gorham, Town of Falkland getting KITs to Saint John Missionary Baptist Church, other churches and organizations plus families & Individuals in rural and urban areas;
• Bishop James E. Tripp, only African American on the Pitt County School Board, District 3; Spokesperson for SAY YES COVID TEST-PITT COUNTY.
• Eastern North Carolina Regional Association of Black Social Workers.
• Mildred A. Council, MSW, Community Organizer/Advocate/Spokesperson for SAY YES COVID TEST-PITT COUNTY.

Mildred Council says, “We wanted to have youth reflected on the group. However, we couldn’t invite one at that time because it was very private so, I represented them as volunteer leader of the Pitt County 4H Volunteer Club.”

After convening, the focus group decided to inform the oversight team, based in Raleigh, (NIH, Center for Disease Control, Duke University, University of North Carolina-Chapel Hill, and North Carolina Central University as well as others, that they could not be just a Greenville initiative because they didn’t think that it was reflective of our communities. Council says, “So, we told the people in Raleigh that we did not want to do Greenville only; we thought that it should be all of Pitt County.”

After all of Pitt County was included in the pilot, Council became community organizer and set about the task of contacting the ten municipalities of the county: City of Greenville, Towns: Ayden, Bethel, Falkland, Farmville, Fountain, Grifton, Grimesland, and Winterville; and the Village of Simpson. Due to the level of poverty and disparate services to Black and Brown constituents in the region, the strategy included offering Black elected officials the opportunity to endorse and participate in the initiative. All of them agreed to have at least one representative involved if they could not personally participate. The only municipality not having an elected official is Grimesland and it was represented by another town.

Bishop James E. Tripp, one of the original members of the focus group, highlights the importance of including all of Pitt County by pointing out, “I’ve lost family members and friends to Covid-19. I’m excited about this initiative. It hurts when you know people who have died from it.” And he also points out that, “people ‘north of the river’ (Tar River) are neglected”. This is another indicator of the importance of in-home testing. Even so, he cites a person he knew who had both vaccinations and still died from Covid-19 related pneumonia. Yet, he has no doubt that in-home testing is going to make a difference.

Part of the organizing effort was to establish Covid-19 test kit distribution centers in addition to using other creative approaches for getting them to the public such as health fairs, vaccination points, door-to-door in housing developments, retail businesses, and significant participation by churches throughout the county.

Before handing out the kits, all those involved with organizing and distribution had educational sessions and training to effectively guide the process. The Raleigh team met with the county medical provider of the project, Vidant Medical Center, Greenville Housing Authority, and the Pitt County Health Department. They met separate from the Pitt County focus group. Other partners of the project include public agencies such as the Post Office, Pitt County Schools, and Amexican Community, which represents the county’s Latino Community and its civic engagement.

The importance of the churches as distribution points was crucial to the project. But issues of receiving shipments at the various locations developed and the need for a central shipping and distribution center was resolved when Pastor Rodney Coles, CEO of Churches Outreach Network,  a multi-services faith-based organization, resolved the matter when he joined the effort and offered his outreach ministries’ warehouse as the platform. Each of the five distribution centers now pickup their kits from that location. Those five centers are:

1. Holly Hill Original Freewill Baptist Church (Belvoir),
2. Philipi Church of Christ (Greenville),
3. Philipi Missionary Baptist Church (Simpson),
4. Sycamore Hill Baptist Church (Greenville), and
5. American Legion Post 160 and 100 Black Men (Greenville).

So, what is all the excitement and dedication to getting the Covid-19 in-home testing kits into the homes of distressed communities, especially Black and Brown people, during this pilot?

Valerie Gatlin Walker, MSN, RN, NE-BC Health Coach and member of the focus group says, “I’m promoting this because if you know you are positive, as soon as you’re positive, the sooner you can get help. And hopefully it can be treated and not have any major symptoms. A lot of times people just don’t know that they are infected and then they go out and infect someone else. So, I see spreading this test to everyone in the community helps with the fight against Covid.” Adding, “My health ministry at church has helped me and they are all onboard with this and it has been an honor that we were included. A lot of times the rural areas don’t get included in projects like this and so I am happy and honored that my church could help support the community.”

To date over 25,000 kits have been distributed during the pilot which ended May 23, 2021. It was supposed to have lasted four weeks but was extended another two weeks. The initial goal was to distribute 30,000 boxes or kits. Each box contains twenty-five tests to be used three times per week every other day: Monday, Wednesday, Friday or Tuesday, Thursday, Saturday. Instructions are included in the kits and, as stated earlier, training took place for organizers who oversee distribution. Questions related to those needing to take the test if they have completed vaccinations have arisen. Ann Floyd Huggins, Pitt County Board of Commissioners and Focus Group Chair advises, “When we started passing out the kit, people would ask: ‘Okay, I’ve had both of my vaccinations. Do I still need the kit?’ That was a question we got asked. So, part of the education piece is to explain why you still need to get the kit and use it after taking both vaccinations.” The CDC supports her statement: “COVID-19 vaccines are effective. However, a small percentage of people who are fully vaccinated will still get COVID-19 if they are exposed to the virus that causes it. These infections are defined as ‘vaccine breakthrough cases.’”

Here are a few other quotes attesting to the excitement and participation generated by “Say Yes! To the Test demonstration:

• Minerva Freeman representing Commissioner James Larry Gorham, First Black Commissioner, Town of Falkland, “Most of the people at my church have gotten the Covid-19 vaccine. We saw to it that everybody has gotten the vaccine through helping them set up appointments. So, this (project) is more less to see if the vaccine is working.”
• Veronica Roberson, Councilmember,Town of Winterville, NC and Coordinator for three Municipalities–Winterville, Ayden and Grifton, NC, “When Mildred (Council) called me, I was very excited about the project. I thought it was a really good project to do in our area. I was excited about everything. So, I called my pastor and got permission to use the church as a distribution site and got support from our church members. I also went out into the community….So, when the boxes came, everybody was ready.”
• William T. Atkinson, Pasico Norfleet American Legion Post 160-Targets Veterans & Families & Community at Large. Partners with 100 Black Men Organization, “So many people took part in getting the kits out. I just want to thank everyone for just allowing us to serve you. One Hundred Black Men came by. We had vaccine day. Recently on Saturday we had a great event over here at West Green Park. Some of the people from the Council came by our tent. All part of the test….We will continue if need be. Whatever we need to do we’ll make it happen.”

Pitt County being an excellent example, the Chattanooga demonstration organizers wanted some insights into launching theirs a few weeks ago. Mildred gave a glimpse into the conversation, “We talked with the Black pastors and some of our team members shared what our experience has been like and they are ready to get started in Chattanooga.” And Bishop Tripp went further, “I told them if they would fly me out there, I would work with them to organize.”

That brings up several questions. What are the performance expectations of NIH for Pitt County? Are participants being surveyed for comments and/or results? How do they determine whether NIH views the project as successful, needs more work, or is valid? Will there be any follow-up from NIH? And it also raises the question of remuneration. Is anyone getting paid to do this?

Nearing the completion date, the project had distributed over 15,000 kits. The goal is 30,000 and just working four weeks, they had not had a chance to get it all done and that caused the pilot to be extended. Those who wish to participate in being surveyed can opt-in and participants are rewarded for being part of the more detailed research with a gift certificate.

Researchers at NIH-supported University of North Carolina at Chapel Hill, and Duke University and the Duke Clinical Research Institute – both in Durham, N.C. – will work with the CDC and NIH to use publicly available COVID-19 case-surveillance data on test-positivity rates, coronavirus-related illness, and hospitalizations and measurements of viral particles in sewage wastewater to evaluate viral transmission in the community.

At the same time, publicly available data will be reviewed from other communities of similar size that have not received widespread self-administered tests to provide a basis of comparison. If testing is shown to be effective, then the hope is that at-home testing will be more accepted and widely distributed, potentially introducing a new means of combating the virus.

Say Yes! Covid Test” Pitt County is summed up by the community organizer, Mildred Council, “The power of this is that the African American community has been in charge of this project. We’ve been able to take the leadership, which is very seldom done. Usually, we get the little crumbs at the end. But we’ve had an opportunity to do this work first. And of course, we don’t turn anyone down.”

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