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  1. Lane-Barlow, Christi MSc
  2. Thomas, Isabel MPH
  3. Horter, Libby MPH
  4. Fleurence, Rachael PhD
  5. Green, Jamilla DrPH
  6. Juluru, Krishna MD
  7. Byrkit, Ramona MPH
  8. Weitz, Andrew PhD
  9. Ricaldi, Jessica N. MD, PhD
  10. Valencia, Diana MSc


Context: Health departments (HDs) work on the front lines to ensure the health of their communities, providing a unique perspective to public health response activities. Say Yes! COVID Test (SYCT) is a US federally funded program providing free COVID-19 self-tests to communities with high COVID-19 transmission, low vaccination rates, and high social vulnerability. The collaboration with 9 HDs was key for the program distribution of 5.8 million COVID-19 self-tests between March 31 and November 30, 2021.


Objective: The objective of this study was to gather qualitative in-depth information on the experiences of HDs with the SYCT program to better understand the successes and barriers to implementing community-focused self-testing programs.


Design: Key informant (KI) interviews.


Setting: Online interviews conducted between November and December 2021.


Participants: Sixteen program leads representing 9 HDs were purposefully sampled as KIs. KIs completed 60-minute structured interviews conducted by one trained facilitator and recorded.


Main Outcome Measures: Key themes and lessons learned were identified using grounded theory.


Results: Based on perceptions of KIs, HDs that maximized community partnerships for test distribution were more certain that populations at a higher risk for COVID-19 were reached. Where the HD relied predominantly on direct-to-consumer distribution, KIs were less certain that communities at higher risk were served. Privacy and anonymity in testing were themes linked to higher perceived community acceptance. KIs reported that self-test demand and distribution levels increased during higher COVID-19 transmission levels.


Conclusion: HDs that build bridges and engage with community partners and trusted leaders are better prepared to identify and link high-risk populations with health services and resources. When collaborating with trusted community organizations, KIs perceived that the SYCT program overcame barriers such as mistrust of government intervention and desire for privacy and motivated community members to utilize this resource to protect themselves against COVID-19.