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Hayden MK, Hanson KE, Englund JA, Lee F, Lee MJ, Loeb M, Morgan DJ, Patel R, El Alayli A, El Mikati IK, Sultan S, Falck-Ytter Y, Mansour R, Amarin JZ, Morgan RL, Murad MH, Patel P, Bhimraj A, Mustafa RA. The Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Antigen Testing (January 2023). Clin Infect Dis 2024; 78:e350-e384. [PMID: 36702617 DOI: 10.1093/cid/ciad032] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
Immunoassays designed to detect SARS-CoV-2 protein antigens (Ag) are commonly used to diagnose COVID-19. The most widely used tests are lateral flow assays that generate results in approximately 15 minutes for diagnosis at the point-of-care. Higher throughput, laboratory-based SARS-CoV-2 Ag assays have also been developed. The number of commercially available SARS-CoV-2 Ag detection tests has increased rapidly, as has the COVID-19 diagnostic literature. The Infectious Diseases Society of America (IDSA) convened an expert panel to perform a systematic review of the literature and develop best-practice guidance related to SARS-CoV-2 Ag testing. This guideline is an update to the third in a series of frequently updated COVID-19 diagnostic guidelines developed by the IDSA. IDSA's goal was to develop evidence-based recommendations or suggestions that assist clinicians, clinical laboratories, patients, public health authorities, administrators, and policymakers in decisions related to the optimal use of SARS-CoV-2 Ag tests in both medical and nonmedical settings. A multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review identified and prioritized clinical questions related to the use of SARS-CoV-2 Ag tests. A review of relevant, peer-reviewed published literature was conducted through 1 April 2022. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel made 10 diagnostic recommendations that address Ag testing in symptomatic and asymptomatic individuals and assess single versus repeat testing strategies. US Food and Drug Administration (FDA) SARS-CoV-2 Ag tests with Emergency Use Authorization (EUA) have high specificity and low to moderate sensitivity compared with nucleic acid amplification testing (NAAT). Ag test sensitivity is dependent on the presence or absence of symptoms and, in symptomatic patients, on timing of testing after symptom onset. In most cases, positive Ag results can be acted upon without confirmation. Results of point-of-care testing are comparable to those of laboratory-based testing, and observed or unobserved self-collection of specimens for testing yields similar results. Modeling suggests that repeat Ag testing increases sensitivity compared with testing once, but no empirical data were available to inform this question. Based on these observations, rapid RT-PCR or laboratory-based NAAT remain the testing methods of choice for diagnosing SARS-CoV-2 infection. However, when timely molecular testing is not readily available or is logistically infeasible, Ag testing helps identify individuals with SARS-CoV-2 infection. Data were insufficient to make a recommendation about the utility of Ag testing to guide release of patients with COVID-19 from isolation. The overall quality of available evidence supporting use of Ag testing was graded as very low to moderate.
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Affiliation(s)
- Mary K Hayden
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kimberly E Hanson
- Divisions of Infectious Diseases and Clinical Microbiology, University of Utah, Salt Lake City, Utah, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Francesca Lee
- Departments of Pathology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mark J Lee
- Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark Loeb
- Division of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, and the Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Abdallah El Alayli
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Ibrahim K El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
| | - Yngve Falck-Ytter
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
- VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Razan Mansour
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Justin Z Amarin
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca L Morgan
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - M Hassan Murad
- Division of Public Health, Infectious diseases and occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Payal Patel
- Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Lee GYL, Lim RBT. Are self-test kits still relevant post COVID-19 pandemic? Qualitative study on working adults' perceptions. Infect Dis Health 2024; 29:73-80. [PMID: 38049368 DOI: 10.1016/j.idh.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Other than self-isolation measures, self-testing is likely to reduce the transmission of COVID-19 and may become a valuable approach in future outbreaks of infectious diseases. This study delves into the perceptions and experiences of working adults who utilised COVID-19 self-test kits in Singapore during the post-pandemic period. METHODS Employing a qualitative descriptive design, in-depth interviews were conducted with 40 working adults from diverse occupations, with a median age of 35 years. Thematic analysis of transcribed interviews was carried out by two independent qualitative research-trained researchers. RESULTS Facilitators included personal motivations like safeguarding vulnerable individuals and the convenience of user-friendly self-test kits. Proximal environmental factors encompassed situations involving close contacts and large gatherings, while distal factors involved workplace regulations, public health campaigns, mass media influence, and trust in authorised kits. Nonetheless, barriers include discomfort, cost, uncertainty about proper technique, and evolving testing requirements. Positive test results prompted participants to notify contacts and self-isolate, whereas negative results encouraged a return to normalcy. Participants recommend sustained testing for new variants and vulnerable groups, though some view it as unnecessary due to pandemic normalisation. CONCLUSIONS Self-testing emerged as a social phenomenon influenced by societal obligations and relationships across multiple levels. Effective communication strategies may play a role in fostering trust and ensuring that working adults sustain the practice of self-testing; therefore, further research is needed to explore their potential impact. Such efforts could be valuable for maintaining vigilance and achieving effective disease control in the post-COVID-19 pandemic landscape.
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Affiliation(s)
- Gladys Yu Lin Lee
- Health Sciences Authority, 11 Biopolis Way #11-01 Helios, Singapore 138667, Singapore City, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore City, Singapore.
| | - Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore City, Singapore.
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Junger N, Hirsch O. Ethics of Nudging in the COVID-19 Crisis and the Necessary Return to the Principles of Shared Decision Making: A Critical Review. Cureus 2024; 16:e57960. [PMID: 38601812 PMCID: PMC11005480 DOI: 10.7759/cureus.57960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 04/12/2024] Open
Abstract
Nudging, a controversial technique for modifying people's behavior in a predictable way, is claimed to preserve freedom of choice while simultaneously influencing it. Nudging had been largely confined to situations such as promoting healthy eating choices but has been employed in the coronavirus disease 2019 (COVID-19) crisis in a shift towards measures that involve significantly less choice, such as shoves and behavioral prods. Shared decision making (SDM), a method for direct involvement and autonomy, is an alternative approach to communicate risk. Predominantly peer-reviewed scientific publications from standard literature databases like PubMed, PsycInfo, and Psyndex were evaluated in a narrative review. The so-called fear nudges, as well as the dissemination of strongly emotionalizing or moralizing messages can lead to intense psycho-physical stress. The use of these nudges by specialized units during the COVID-19 pandemic generated a societal atmosphere of fear that precipitated a deterioration of the mental and physical health of the population. Major recommendations of the German COVID-19 Snapshot Monitoring (COSMO) study, which are based on elements of nudging and coercive measures, do not comply with ethical principles, basic psychological principles, or evidence-based data. SDM was misused in the COVID-19 crisis, which helped to achieve one-sided goals of governments. The emphasis on utilitarian thinking is criticized and the unethical behavior of decision makers is explained by both using the concept of moral disengagement and the maturity level of coping strategies. There should be a return to an open-ended, democratic, and pluralistic scientific debate without using nudges. It is therefore necessary to return to the origins of SDM.
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Affiliation(s)
- Nancy Junger
- Psychology, Independent Researcher, Tübingen, DEU
| | - Oliver Hirsch
- Psychology, FOM University of Applied Sciences, Siegen, DEU
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4
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Zomer CL, Kroese F, Sanders JG, Janssen R, de Bruin M. Estimating the impact of COVID-19 self-test availability and modifications in test-strategy on overall test uptake using an experimental vignette study. Sci Rep 2024; 14:5887. [PMID: 38467654 PMCID: PMC10928216 DOI: 10.1038/s41598-024-54988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/19/2024] [Indexed: 03/13/2024] Open
Abstract
To inform future Dutch COVID-19 testing policies we did an experimental vignette study to investigate whether inclusion of the less reliable lateral flow tests (self-tests) would change test-uptake sufficiently to improve population-level test sensitivity. A representative sample (n = 3,270) participated in a 2-by-2 online experiment to evaluate the effects of test-guidelines including self-testing advice (IV1), and the effects of self-test availability (IV2) on expected test uptake (PCR test, self-test or no test) and sensitivity of the overall test strategy (primary outcome). Across four scenarios, changing test advice did not affect expected testing behaviour. Self-test availability, however, increased the timeliness of testing, the number of people testing, and overall test strategy sensitivity. Based on these findings, we recommend that (national) policy facilitates a supply of self-tests at home, for example through free and pro-active distribution of test-kits during a pandemic. This could substantially enhance the chances of timely detecting and isolating patients.
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Affiliation(s)
- Colene L Zomer
- Corona Behavioural Unit, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
- Radboud University Medical Center, Institute of Health Sciences, Nijmegen, The Netherlands.
| | - Floor Kroese
- Corona Behavioural Unit, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Jet G Sanders
- Corona Behavioural Unit, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
- Department of Psychological and Behavioural Science, London School of Economics and Political Sciences, London, UK
| | - Riny Janssen
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Marijn de Bruin
- Corona Behavioural Unit, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
- Radboud University Medical Center, Institute of Health Sciences, Nijmegen, The Netherlands
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Anand A, Vialard F, Esmail A, Ahmad Khan F, O’Byrne P, Routy JP, Dheda K, Pant Pai N. Self-tests for COVID-19: What is the evidence? A living systematic review and meta-analysis (2020-2023). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002336. [PMID: 38324519 PMCID: PMC10849237 DOI: 10.1371/journal.pgph.0002336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024]
Abstract
COVID-19 self-testing strategy (COVIDST) can rapidly identify symptomatic and asymptomatic SARS-CoV-2-infected individuals and their contacts, potentially reducing transmission. In this living systematic review, we evaluated the evidence for real-world COVIDST performance. Two independent reviewers searched six databases (PubMed, Embase, Web of Science, World Health Organization database, Cochrane COVID-19 registry, Europe PMC) for the period April 1st, 2020, to January 18th, 2023. Data on studies evaluating COVIDST against laboratory-based conventional testing and reported on diagnostic accuracy, feasibility, acceptability, impact, and qualitative outcomes were abstracted. Bivariate random effects meta-analyses of COVIDST accuracy were performed (n = 14). Subgroup analyses (by sampling site, symptomatic/asymptomatic infection, supervised/unsupervised strategy, with/without digital supports) were conducted. Data from 70 included studies, conducted across 25 countries with a median sample size of 817 (range: 28-784,707) were pooled. Specificity and DOR was high overall, irrespective of subgroups (98.37-99.71%). Highest sensitivities were reported for: a) symptomatic individuals (73.91%, 95%CI: 68.41-78.75%; n = 9), b) mid-turbinate nasal samples (77.79%, 95%CI: 56.03-90.59%; n = 14), c) supervised strategy (86.67%, 95%CI: 59.64-96.62%; n = 13), and d) use of digital interventions (70.15%, 95%CI: 50.18-84.63%; n = 14). Lower sensitivity was attributed to absence of symptoms, errors in test conduct and absence of supervision or a digital support. We found no difference in COVIDST sensitivity between delta and omicron pre-dominant period. Digital supports increased confidence in COVIDST reporting and interpretation (n = 16). Overall acceptability was 91.0-98.7% (n = 2) with lower acceptability reported for daily self-testing (39.5-51.1%). Overall feasibility was 69.0-100.0% (n = 5) with lower feasibility (35.9-64.6%) for serial self-testing. COVIDST decreased closures in school, workplace, and social events (n = 4). COVIDST is an effective rapid screening strategy for home-, workplace- or school-based screening, for symptomatic persons, and for preventing transmission during outbreaks. These data will guide COVIDST policy. Our review demonstrates that COVIDST has paved the way for self-testing in pandemics worldwide.
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Affiliation(s)
- Apoorva Anand
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Fiorella Vialard
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology, UCT Lung Institute and Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Faiz Ahmad Khan
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Patrick O’Byrne
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, UCT Lung Institute and Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nitika Pant Pai
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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6
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Herbert C, Shi Q, Baek J, Wang B, Kheterpal V, Nowak C, Suvarna T, Singh A, Hartin P, Durnam B, Schrader S, Harman E, Gerber B, Barton B, Zai A, Cohen-Wolkowiez M, Corbie-Smith G, Kibbe W, Marquez J, Hafer N, Broach J, Lin H, Heetderks W, McManus DD, Soni A. Association of neighborhood-level sociodemographic factors with Direct-to-Consumer (DTC) distribution of COVID-19 rapid antigen tests in 5 US communities. BMC Public Health 2023; 23:1848. [PMID: 37735647 PMCID: PMC10515232 DOI: 10.1186/s12889-023-16642-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Many interventions for widescale distribution of rapid antigen tests for COVID-19 have utilized online, direct-to-consumer (DTC) ordering systems; however, little is known about the sociodemographic characteristics of home-test users. We aimed to characterize the patterns of online orders for rapid antigen tests and determine geospatial and temporal associations with neighborhood characteristics and community incidence of COVID-19, respectively. METHODS This observational study analyzed online, DTC orders for rapid antigen test kits from beneficiaries of the Say Yes! Covid Test program from March to November 2021 in five communities: Louisville, Kentucky; Indianapolis, Indiana; Fulton County, Georgia; O'ahu, Hawaii; and Ann Arbor/Ypsilanti, Michigan. Using spatial autoregressive models, we assessed the geospatial associations of test kit distribution with Census block-level education, income, age, population density, and racial distribution and Census tract-level Social Vulnerability Index. Lag association analyses were used to measure the association between online rapid antigen kit orders and community-level COVID-19 incidence. RESULTS In total, 164,402 DTC test kits were ordered during the intervention. Distribution of tests at all sites were significantly geospatially clustered at the block-group level (Moran's I: p < 0.001); however, education, income, age, population density, race, and social vulnerability index were inconsistently associated with test orders across sites. In Michigan, Georgia, and Kentucky, there were strong associations between same-day COVID-19 incidence and test kit orders (Michigan: r = 0.89, Georgia: r = 0.85, Kentucky: r = 0.75). The incidence of COVID-19 during the current day and the previous 6-days increased current DTC orders by 9.0 (95% CI = 1.7, 16.3), 3.0 (95% CI = 1.3, 4.6), and 6.8 (95% CI = 3.4, 10.2) in Michigan, Georgia, and Kentucky, respectively. There was no same-day or 6-day lagged correlation between test kit orders and COVID-19 incidence in Indiana. CONCLUSIONS Our findings suggest that online ordering is not associated with geospatial clustering based on sociodemographic characteristics. Observed temporal preferences for DTC ordering can guide public health messaging around DTC testing programs.
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Affiliation(s)
- Carly Herbert
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
- Center for Clinical and Translational Science, University of Massachusetts, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Qiming Shi
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
- Center for Clinical and Translational Science, University of Massachusetts, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Biqi Wang
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
| | | | | | | | - Aditi Singh
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
| | - Paul Hartin
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
| | | | | | | | - Ben Gerber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Adrian Zai
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Giselle Corbie-Smith
- Department of Social Medicine, Department of Medicine, Center for Health Equity Research, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Warren Kibbe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Juan Marquez
- Washtenaw County Health Department, Washtenaw, MI, USA
| | - Nathaniel Hafer
- Center for Clinical and Translational Science, University of Massachusetts, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - John Broach
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Honghuang Lin
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
| | - William Heetderks
- National Institute of Biomedical Imaging and Bioengineering, NIH, Via Contract With Kelly Services, Bethesda, MD, USA
| | - David D McManus
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
- Division of Cardiology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Apurv Soni
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA.
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Division of Health System Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
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7
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Kawuki J, Fang Y, Yu FY, Ye D, Chan PSF, Chen S, Wang Z. Facilitators and barriers to use rapid antigen test for SARS-CoV-2 among community-dwelling older adults in Hong Kong: A population-based cross-sectional random telephone survey. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002196. [PMID: 37552663 PMCID: PMC10409272 DOI: 10.1371/journal.pgph.0002196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023]
Abstract
Faster diagnosis of Coronavirus disease 2019 (COVID-19) is crucial for surveillance, prompt implementation of infection control measures and adequate patient care among older adults. This study investigated the behavioral intention to use Rapid Antigen Tests (RAT) and associated factors among older adults in Hong Kong for health monitoring and when having COVID-19-like symptoms. This was a population-based cross-sectional random telephone survey of 370 Chinese-speaking adults aged ≥65 years. The behavioral intention to use RAT was the main outcome, and logistic regression models were used to assess the associated factors, using SPSS (version 26.0.). Results indicate that among the participants, 90.3% had used RAT, of which 21.6% obtained positive results. The common challenges faced when using RAT included: difficulty choosing the right RAT kit, uncertainty about how to use RAT, and not knowing what to do after getting a positive result. Additionally, 27.3% intended to use RAT regularly for health status monitoring without any symptoms, while 87.0% if they had COVID-19-like symptoms. After adjustment for significant background characteristics, positive attitudes, perceiving Hong Kong government and their children and/or other family members would support them using RAT, belief that RAT health promotion materials were helpful to understand how to use RAT and thoughtful consideration of the veracity of COVID-19 specific information were associated with higher behavioral intention to use RAT both when having no symptoms and in presence of COVID-19-like symptoms. Having negative attitudes toward RAT was associated with a lower intention of RAT use only when having no symptoms. Addressing difficulties faced when using RAT, strengthening positive attitudes, involving significant others and empowering with adequate information-veracity evaluating skills are potentially vital strategies to increase RAT use among older adults.
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Affiliation(s)
- Joseph Kawuki
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuan Fang
- Department of Health and Physical Education, the Education University of Hong Kong, Hong Kong, China
| | - Fuk-yuen Yu
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Danhua Ye
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Paul Shing-fong Chan
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Siyu Chen
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Zixin Wang
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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8
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Palma G, Caprioli D, Mari L. Epidemic Management via Imperfect Testing: A Multi-criterial Perspective. Bull Math Biol 2023; 85:66. [PMID: 37296314 PMCID: PMC10255952 DOI: 10.1007/s11538-023-01172-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
Diagnostic testing may represent a key component in response to an ongoing epidemic, especially if coupled with containment measures, such as mandatory self-isolation, aimed to prevent infectious individuals from furthering onward transmission while allowing non-infected individuals to go about their lives. However, by its own nature as an imperfect binary classifier, testing can produce false negative or false positive results. Both types of misclassification are problematic: while the former may exacerbate the spread of disease, the latter may result in unnecessary isolation mandates and socioeconomic burden. As clearly shown by the COVID-19 pandemic, achieving adequate protection for both people and society is a crucial, yet highly challenging task that needs to be addressed in managing large-scale epidemic transmission. To explore the trade-offs imposed by diagnostic testing and mandatory isolation as tools for epidemic containment, here we present an extension of the classical Susceptible-Infected-Recovered model that accounts for an additional stratification of the population based on the results of diagnostic testing. We show that, under suitable epidemiological conditions, a careful assessment of testing and isolation protocols can contribute to epidemic containment, even in the presence of false negative/positive results. Also, using a multi-criterial framework, we identify simple, yet Pareto-efficient testing and isolation scenarios that can minimize case count, isolation time, or seek a trade-off solution for these often contrasting epidemic management objectives.
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Affiliation(s)
- Giuseppe Palma
- Institute of Nanotechnology, National Research Council, Campus Ecotekne, Via Monteroni, 73100 Lecce, LE Italy
| | - Damiano Caprioli
- Department of Astronomy & Astrophysics, E. Fermi Institute, University of Chicago, 5640 South Ellis Avenue, Chicago, IL 60637 USA
| | - Lorenzo Mari
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Via Ponzio 34/5, 20133 Milano, MI Italy
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9
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Wu F, Yuan Y, Li Y, Yin D, Lang B, Zhao Y, Fan X, Zou H, Zhang C, Zeng X, Sun C. The acceptance of SARS-CoV-2 rapid antigen self-testing: A cross-sectional study in China. J Med Virol 2023; 95:e28227. [PMID: 36241424 PMCID: PMC9874789 DOI: 10.1002/jmv.28227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/07/2022] [Accepted: 10/12/2022] [Indexed: 01/27/2023]
Abstract
Compared with the nucleic acid amplification test (NATT), the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapid antigen self-testing (RAST) has advantages in speed and convenience. However, little is known about people's acceptance and influencing factors for SARS-CoV-2 RAST. A cross-sectional study was conducted from April 21 to 30, 2022 in China. The χ2 test and multivariate logistic regressions were used to identify the influencing factors. The structural equation model was used to test the extended protective motivation theory (PMT) model hypotheses. Among the total of 5107 participants, 62.5% were willing to accept the SARS-CoV-2 RAST. There were significant differences in acceptance among different residences (p < 0.001), educational level (p < 0.001), occupation (p < 0.001), monthly income (p < 0.001), travel frequency (p < 0.05), and feelings about NATT (p < 0.001). Response efficacy (β = 0.05; p = 0.025) and self-efficacy (β = 0.84; p < 0.001) had a positive effect, while response cost showed a negative effect (β = -0.07; p < 0.001). The public's major concerns about SARS-CoV-2 RAST are its reliability, testing method, price, and authority. Overall, a moderate intention to use SARS-CoV-2 RAST was found among the Chinese population. The extended PMT can be used for the prediction of intention to accept the RAST. We need to take measures to increase people's acceptance of SARS-CoV-2 RAST.
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Affiliation(s)
- Fan Wu
- School of Public Health (Shenzhen)Shenzhen Campus of Sun Yat‐sen UniversityShenzhenChina
| | - Yue Yuan
- School of Public Health (Shenzhen)Shenzhen Campus of Sun Yat‐sen UniversityShenzhenChina
| | - Yanjun Li
- Foshan Center for Disease Control and PreventionFoshanChina
| | - Di Yin
- School of Public Health (Shenzhen)Shenzhen Campus of Sun Yat‐sen UniversityShenzhenChina
| | - Bing Lang
- School of Public Health (Shenzhen)Shenzhen Campus of Sun Yat‐sen UniversityShenzhenChina
| | - Yangguo Zhao
- School of Public Health (Shenzhen)Shenzhen Campus of Sun Yat‐sen UniversityShenzhenChina
| | - Xueying Fan
- School of Public Health (Shenzhen)Shenzhen Campus of Sun Yat‐sen UniversityShenzhenChina
| | - Huachun Zou
- School of Public Health (Shenzhen)Shenzhen Campus of Sun Yat‐sen UniversityShenzhenChina
| | - Chunhuan Zhang
- Guangzhou Center for Disease Control and PreventionGuangzhouChina
| | - Xiangyue Zeng
- Guangzhou Liwan District Center for Disease Control and PreventionGuangzhouChina
| | - Caijun Sun
- School of Public Health (Shenzhen)Shenzhen Campus of Sun Yat‐sen UniversityShenzhenChina,Key Laboratory of Tropical Disease Control (Sun Yat‐sen University), Ministry of EducationGuangzhouChina
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10
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Hajek A, Nedjad M, Kretzler B, König HH. [Use of and Attitudes toward Tests for the Detection of SARS-CoV-2 and Corresponding Antibodies: Results of a Nationally Representative Survey in Late Summer 2021]. DAS GESUNDHEITSWESEN 2023; 85:26-35. [PMID: 36084943 PMCID: PMC11248198 DOI: 10.1055/a-1916-9895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE There is a lack of knowledge regarding utilization of and attitudes towards tests for the detection of SARS-CoV-2 in Germany. Our work aimed to reduce this gap. METHODS Data were taken from a nationally representative online survey (August 24th to 3rd September 2021, n=3,075; mean age: 44.5 years). Utilization of and attitudes toward Covid-19-tests were quantified in detail. RESULTS In sum, 79.1% of respondents had already undergone an appropriate test to detect SARS-CoV-2 test (mainly rapid antigen testing at rapid testing centers and self-testing) or an antibody test. With the exception of a PCR test, Covid-19 tests were rarely perceived as uncomfortable. Respondents were most likely to prefer a rapid antigen test in a rapid testing center. The main reasons for using self-testing as well as rapid antigen testing at rapid testing centers were (i) protection of others, (ii) for their own health precautions, and (iii) traveling. The main reasons for not using self-testing/rapid antigen testing at the workplace/training center were: (i) already vaccinated against Covid-19/recovered from Covid-19, followed by (ii) the home office workplace, and (iii) a lack of perceived benefit. Nearly 80% were somewhat or very satisfied, with access to testing at the workplace/training center and rapid testing centers. CONCLUSION Our work described the use of and aspects of attitudes toward tests for the detection of SARS-CoV-2 in Germany in late summer 2021. At that time, such test offers were already used quite often and were predominantly perceived as not being very unpleasant. The protection of other individuals was one of the main reasons for the use of such tests. Future research in this area is desirable (e. g., among the oldest old and in times when free-of-charge testing is no longer offered).
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Affiliation(s)
- André Hajek
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Deutschland
| | - MiladAhmad Nedjad
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Deutschland
| | - Benedikt Kretzler
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Deutschland
| | - Hans-Helmut König
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Deutschland
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11
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Jenny MA, Betsch C. Large-scale behavioural data are key to climate policy. Nat Hum Behav 2022; 6:1444-1447. [DOI: 10.1038/s41562-022-01479-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Stokes W, Berenger BM, Venner AA, Deslandes V, Shaw JLV. Point of care molecular and antigen detection tests for COVID-19: current status and future prospects. Expert Rev Mol Diagn 2022; 22:797-809. [PMID: 36093682 DOI: 10.1080/14737159.2022.2122712] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Detection of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been critical to support and management of the COVID-19 pandemic. Point of care testing (POCT) for SARS-CoV-2 has been a widely used tool for detection of SARS-CoV-2. AREAS COVERED POCT nucleic acid amplification tests (NAATs) and rapid antigen tests (RATs) have been the most readily used POCT for SARS-CoV-2. Here, current knowledge on the utility of POCT NAATs and RATs for SARS-CoV-2 are reviewed and discussed alongside aspects of quality assurance factors that must be considered for successful and safe implementation of POCT. EXPERT OPINION Use cases for implementation of POCT must be evidence based, regardless of the test used. A quality assurance framework must be in place to ensure accuracy and safety of POCT.
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Affiliation(s)
- William Stokes
- Alberta Precision Laboratories, Alberta, Canada.,Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Byron M Berenger
- Alberta Precision Laboratories, Alberta, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Allison A Venner
- Alberta Precision Laboratories, Alberta, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vincent Deslandes
- Eastern Ontario Regional Laboratories Association, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Julie L V Shaw
- Eastern Ontario Regional Laboratories Association, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Ottawa, Ontario, Canada
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13
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Betsch C, Sprengholz P, Siegers R, Eitze S, Korn L, Goldhahn L, Schmitz JM, Giesler P, Knauer G, Jenny MA. Empirical evidence to understand the human factor for effective rapid testing against SARS-CoV-2. Proc Natl Acad Sci U S A 2021; 118:e2107179118. [PMID: 34362848 PMCID: PMC8364214 DOI: 10.1073/pnas.2107179118] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapid antigen point-of-care and home tests are available to laypeople. In four cross-sectional mixed-methods data collections conducted between December 2020 and March 2021 (n = 4,026), we showed that a majority of subjects were willing to test despite mistrust and ignorance regarding rapid tests' validity. Experimental evidence shows that low costs and access to events could increase testing intentions. Mandatory reporting and isolation after positive results were not identified as major barriers. Instead, assuming that testing and isolation can slow down the pandemic and the possibility to protect others were related to greater willingness to get tested. While we did not find evidence for risk compensation for past tests, experimental evidence suggests that there is a tendency to show less mask wearing and physical distancing in a group of tested individuals. A short communication intervention reduced complacent behavior. The derived recommendations could make rapid testing a successful pillar of pandemic management.
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Affiliation(s)
- Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, 99089 Erfurt, Germany;
- Communication Science, University of Erfurt, 99089 Erfurt, Germany
| | - Philipp Sprengholz
- Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, 99089 Erfurt, Germany
- Communication Science, University of Erfurt, 99089 Erfurt, Germany
| | - Regina Siegers
- Communication Science, University of Erfurt, 99089 Erfurt, Germany
| | - Sarah Eitze
- Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, 99089 Erfurt, Germany
- Communication Science, University of Erfurt, 99089 Erfurt, Germany
| | - Lars Korn
- Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, 99089 Erfurt, Germany
- Communication Science, University of Erfurt, 99089 Erfurt, Germany
| | - Laura Goldhahn
- Communication Science, University of Erfurt, 99089 Erfurt, Germany
| | | | - Paula Giesler
- Communication Science, University of Erfurt, 99089 Erfurt, Germany
| | - Gesine Knauer
- Communication Science, University of Erfurt, 99089 Erfurt, Germany
| | - Mirjam A Jenny
- Science Communication Unit, Robert Koch Institute, 13353 Berlin, Germany
- Center for Adaptive Rationality, Max Planck Institute for Human Development, 14195 Berlin, Germany
- Harding Center for Risk Literacy, University of Potsdam, 14482 Potsdam, Germany
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