Attitudes about COVID-19 Testing among Black Adults in the United States

Purpose

Black Americans are disproportionately affected by coronavirus disease 2019 (COVID-19) hospitalizations and deaths. Decreasing health disparities requires widespread uptake of COVID-19 testing, but attitudes about COVID-19 testing among Black Americans have not been studied. We aimed to characterize knowledge, attitudes, and beliefs about COVID-19 testing among Black parents.

Methods

Semi-structured interviews were conducted and analyzed using a phenomenology approach with 26 self-identified Black parents after telemedicine visits with a children's health center. Interviews were recorded and transcribed; 65% were double coded with a resultant free-marginal interrater kappa score of 86.8%.

Results

Most participants were women, spent time inside the homes of friends or family members, and almost half knew someone diagnosed with COVID-19. Three central themes emerged regarding COVID-19 testing decision making, including: 1) perceived COVID-19 disease susceptibility; 2) barriers to testing, with subthemes including trust in test accuracy and safety, perceived stigma of a positive test result, and impact of racism on self-efficacy; and 3) cues to action.

Conclusions

When considering these themes as constructs of the Health Belief Model, we are better able to understand Black Americans' views of COVID-19 testing and motivations for accessing testing. Culturally responsive educational campaigns delivered by trusted community members should aim to improve understanding about disease transmission and types of tests available. Importantly, framing testing as a means to ensure safety may improve self-efficacy to obtain testing. Lastly, the health community should learn from these conversations with Black Americans so that disease prevention and mitigation strategies prioritize health equity.

Meningococcal disease and vaccination in college students

Neisseria meningitidis is a bacterial pathogen capable of causing rapidly progressing illness from nonspecific symptoms to end-organ failure or death in a matter of hours to days. Despite the availability of meningococcal vaccines, there remains a notable disease incidence peak among individuals aged 18-19 years, with college students at increased risk for disease relative to non-college students. Between 2007 and 2017, as many as one in five colleges in the United States experienced an outbreak of meningococcal disease at their own or a nearby institution. Evidence-based strategies to promote meningococcal vaccination among students can be adapted for the college setting, but barriers exist that limit widespread implementation of these strategies by colleges. In this article, we review meningococcal disease characteristics and epidemiology among US college students, vaccination indications and coverage levels among US college students, as well as college vaccination policies and practices that can impact students' vaccine uptake.

A new method for sequencing the hypervariable Plasmodium falciparum gene var2csa from clinical samples

Background

VAR2CSA, a member of the Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) family, mediates the binding of P. falciparum-infected erythrocytes to chondroitin sulfate A, a surface-associated molecule expressed in placental cells, and plays a central role in the pathogenesis of placental malaria. VAR2CSA is a target of naturally acquired immunity and, as such, is a leading vaccine candidate against placental malaria. This protein is very polymorphic and technically challenging to sequence. Published var2csa sequences, mostly limited to specific domains, have been generated through the sequencing of cloned PCR amplicons using capillary electrophoresis, a method that is both time consuming and costly, and that performs poorly when applied to clinical samples that are commonly polyclonal. A next-generation sequencing platform, Pacific Biosciences (PacBio), offers an alternative approach to overcome these issues.

Methods

PCR primers were designed that target a 5 kb segment in the 5′ end of var2csa and the resulting amplicons were sequenced using PacBio sequencing. The primers were optimized using two laboratory strains and were validated on DNA from 43 clinical samples, extracted from dried blood spots on filter paper or from cryopreserved P. falciparum-infected erythrocytes. Sequence reads were assembled using the SMRT-analysis ConsensusTools module.

Results

Here, a PacBio sequencing-based approach for recovering a segment encoding the majority of VAR2CSA’s extracellular region is described; this segment includes the totality of the first four domains in the 5′ end of var2csa (~5 kb), from clinical malaria samples. The feasibility of the method is demonstrated, showing a high success rate from cryopreserved samples and more limited success from dried blood spots stored at room temperature, and characterized the genetic variation of the var2csa locus.

Conclusions

This method will facilitate a detailed analysis of var2csa genetic variation and can be adapted to sequence other hypervariable P. falciparum genes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12936-017-1976-8) contains supplementary material, which is available to authorized users.