Inclusive Changes to the CityTestSF Experience

San Francisco has a strong track record of leading the way on social progress issues. When CityTestSF launched, the goal was to increase access to COVID-19 testing for all San Franciscans. The program first serviced frontline city employees and soon expanded to all essential workers in the city, as well as symptomatic residents. We launched this work quickly, as a response to a public health crisis, in close collaboration with Mayor Breed, the San Francisco Department of Public Health, and their emergency response team. We’ve managed to serve over 30,000 San Franciscans already, and we’re working as quickly as possible to further expand access to this essential testing. 

Through this work, we discovered a dilemma: certain laboratory requirement regulations, like the Clinical Laboratory Improvement Amendments (CLIA), require clinical testing laboratories to collect ‘sex’ as a part of the test requisition. This refers to physiological sex, which does not always capture and reflect an individual’s gender identity. For some tests, like genetic testing, physiological sex can have a meaningful impact on the interpretation of the test result, but for most tests, this extra data point is simply used as another way to identify the sample and individual, and to make sure that the right information is making it to the right person. Physiological sex does not have an impact on the outcome of COVID-19 testing results.

When developing our genetics product, we met with experts in the LGBTQ+ healthcare space and consulted resources from the Human Rights Campaign, the National Library of Medicine, GLAAD, and the Center of Excellence for Transgender Health at UCSF. Using those learnings and helpful feedback from the population using CityTestSF, we are updating the CityTestSF experience to both follow laboratory regulations and respect the identities of all patients who test there.

In accordance with best practices, we have added an option to the CityTestSF experience to select ‘non-binary’ when choosing sex, as well as an option for individuals to self-report their gender identity. 

We have been honored to support CityTestSF and increase access to testing in San Francisco and we are committed to making the experience simple and painless for everyone who uses it. Staff at the sites have shared remarkable stories of patients feeling more comfortable accessing CityTestSF sites than traversing traditional healthcare routes and we believe the city is modeling the way forward for the rest of the country.