Community-driven secondary distribution of COVID-19 rapid antigen home tests in high-vulnerability Chicago neighborhoods: a community case study.

African American communities on Chicago's South and West Sides, many facing high levels of social vulnerability, experienced disproportionate COVID-19 burden driven in part by limited access to diagnostic testing early in the pandemic. In partnership with the Alive Faith Network (AFN), a longstanding coalition of African American churches and academic partners, we implemented a participant-driven model to expand access to rapid antigen home tests during October 2021-August 2022. Community members distributed 8,386 rapid antigen home tests through their social networks, reaching many individuals who were young, male, and unvaccinated. Survey data were received for 1,555 test kits (18%), representing 1,075 unique individuals, and 602 test results were received. Follow-up calls revealed high acceptability and willingness to test again. Despite a low response rate, this case study highlights how decentralized, trust-based distribution models can overcome structural and behavioral barriers to early detection and extend public health reach into populations historically under-served by conventional approaches, highlighting the value of trusted community infrastructures in advancing health equity.