Courtesy of Katherine Fajardo

A new initiative from the Yale School of Public Health and Yale Pathology Labs hopes to bring low-cost, accessible health services to New Haven — all on four wheels. 

Unveiled at an April 20 meeting on Yale’s West Campus, the Laboratory-in-a-Van initiative aims to bring public health services to historically underserved communities. Using a van retrofitted with laboratory-grade diagnostic equipment, the mobile clinic will employ SalivaDirect — a saliva-based COVID-19 PCR test developed at YSPH — to facilitate on-site testing with a turnaround time of two to three hours. 

“It is a brilliant way to reduce the barriers to testing, instead taking the lab to communities who may be less likely to — or unable to — access the necessary clinic or labs,” Anne Wyllie, one of the project’s principal investigators and the creator of the SalivaDirect testing process, wrote to the News. “We are actively working with our community partners to identify how we can best serve their communities.”

The mobile lab project is funded by the National Institutes of Health’s RadX Underserved Populations program. According to Brittany Choate, the SalivaDirect program manager, the funding will allow the mobile clinic to administer 400 free SalivaDirect COVID-19 tests for uninsured patients through the end of 2023.

To do so, Choate and the mobile lab team are collaborating with city health departments — including those of New Haven and West Haven. The mobile clinic is also partnering with community organizations such as the Alliance for Living, Columbus House, Liberation Programs and the APT Foundation.

Last week’s West Campus announcement of the mobile lab program also included a meeting between YSPH and YPL officials and representatives from these regional partner groups to propose ideas for how to best utilize the van. According to Wyllie, her team is now working to finalize the van’s first appointments.

Within a month, she said, the van should be operational.

“We’re engaging with these community partners because we want to work with them and be respectful of the relationships that they have with their communities, with their constituents and with their clients,” Choate said. “We’re going to be able to partner with them to coordinate where the mobile lab van can go and deploy in conjunction with existing community events. And hopefully, [we can] use that connection with community partners to build trust and … be more effective as a result.”

Earlier in the pandemic, the SalivaDirect team had partnered with Flambeau Diagnostics, a biomedical company specializing in mobile lab testing, to expand access to mobile saliva-based COVID-19 testing. According to Wyllie, the new YSPH and YPL initiative utilizes one of the former Flambeau vans that had been retrofitted for clinical testing.

To outfit the van for administering SalivaDirect, Kat Fajardo, a SalivaDirect lab manager, opted to utilize two portable pieces of equipment to conduct the PCR tests.

The first is a Mic, or Magnetic Induction Cycler, which is a portable PCR machine that can run 46 specimens at a time, according to Fajardo. At six inches by six inches, the Mic leaves a “small footprint on the van itself” while leaving extra space in the van’s benches.

Ordinarily, Fajardo added, PCR machines in laboratories are considerably larger. Given the small size of the Mic machine, the van’s lab technicians can work with specimens on the van’s benches while running a PCR test at the same time. 

The other piece of equipment is a Myra, a portable robotic liquid handler designed to automate the process of moving clinical specimens between vials. Together, according to Fajardo, both the Mic and the Myra work “hand in hand,” to conduct PCR testing. 

“What we wanted to do is run high complexity testing in the van, with a reduced timeframe,” Fajardo said. “And then be able to get the results out to the patients as soon as we possibly can, within a designated two to three hour timeframe.”

According to John Sinard, director of clinical operations at Yale Pathology, a mobile pathology laboratory can bring testing to individuals without a “formal association” with the healthcare system. 

A standard van that collects specimens, he explained, needs to bring samples back to a central lab before getting results to patients — steps that require a patient to have an “identified healthcare provider.” 

With a mobile laboratory, Sinard added, testing can be completed on site and the patient can directly access the results without an intermediary provider.

However, according to Wyllie, the mobile lab will not solely conduct SalivaDirect COVID-19 tests. She expects that the van will also provide more comprehensive public health outreach, including distributing health communication and education materials, supporting vaccination efforts and screening for other infectious and chronic diseases.

Fajardo also described an interest in expanding the van’s capabilities to include tests for other upper respiratory viruses such as influenza, RSV and human metapneumovirus, as well as possible STD testing. 

According to Fajardo, conducting multiplex testing in the van — screening for multiple diseases at the same time — could provide a crucial way to track upper respiratory viruses during flu seasons.

“Let’s say you have an event going on, like a concert, and vans have popped up over the weekend on the [New Haven] Green,” Fajardo said. “So these people who don’t have access to medical care, or even insurance, can come to the vans and test there.”

In order for this initiative to be impactful, both Sinard and Choate emphasized the importance of developing relationships with community organizations that have earned the trust of historically underserved New Haven communities.

Those relationships with community organizations, Choate explained, are a two-way street: public health experts are able to access communities that might be skeptical of health interventions, while also being able to tailor outreach to the communities’ needs.

“Having that trust and engagement with community partners that have been well established is essential for being able to offer these kinds of services,” Choate said. “That way, they can act as ambassadors on our behalf. Beyond that, community leaders can then help us inform the outreach that we’re doing.”

Moving forward, Choate aims to obtain funding to sustain the mobile lab program beyond 2023, especially as the pandemic — per the federal government’s standard — is coming to a close. 

By using the van as a pilot, she hopes to continue offering accessible tests and demonstrate the effectiveness of mobile testing options.

Sinard, however, remains aware of the challenges associated with ensuring high-quality mobile testing. While the team’s on-site evaluation procedures ensure that the van’s testing is as accurate as those conducted in a YSPH or YPL laboratory, mobile testing poses new obstacles.

“This is a new adventure for us,” Sinard wrote. “The mere size of the van and the amount of equipment and reagents which it can accommodate does limit the range of testing which can be offered at any one time. There are also some regulatory hurdles which [need] to be addressed.”

Yet, Choate remains optimistic about the potential of mobile lab testing. She described how the SalivaDirect team is exploring how to use saliva to detect other diseases, including monkeypox and, potentially, diabetes.

Community partners, she explained, are also eager to understand how “mobile deployments” can be used for community health issues beyond COVID-19 and pandemic preparedness.  

“How can we be using these mobile vans for other community health concerns such as gun violence or mental health?” Choate said. “And how can we use these mobile deployments and be able to pop up in communities to offer public health services or education going forward?”

The Yale School of Public Health was founded in 1915.