1
|
O’Laughlin KN, Klabbers RE, Ebna Mannan I, Gentile NL, Geyer RE, Zheng Z, Yu H, Li SX, Chan KCG, Spatz ES, Wang RC, L’Hommedieu M, Weinstein RA, Plumb ID, Gottlieb M, Huebinger RM, Hagen M, Elmore JG, Hill MJ, Kelly M, McDonald S, Rising KL, Rodriguez RM, Venkatesh A, Idris AH, Santangelo M, Koo K, Saydah S, Nichol G, Stephens KA. Ethnic and racial differences in self-reported symptoms, health status, activity level, and missed work at 3 and 6 months following SARS-CoV-2 infection. Front Public Health 2024; 11:1324636. [PMID: 38352132 PMCID: PMC10861779 DOI: 10.3389/fpubh.2023.1324636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction Data on ethnic and racial differences in symptoms and health-related impacts following SARS-CoV-2 infection are limited. We aimed to estimate the ethnic and racial differences in symptoms and health-related impacts 3 and 6 months after the first SARS-CoV-2 infection. Methods Participants included adults with SARS-CoV-2 infection enrolled in a prospective multicenter US study between 12/11/2020 and 7/4/2022 as the primary cohort of interest, as well as a SARS-CoV-2-negative cohort to account for non-SARS-CoV-2-infection impacts, who completed enrollment and 3-month surveys (N = 3,161; 2,402 SARS-CoV-2-positive, 759 SARS-CoV-2-negative). Marginal odds ratios were estimated using GEE logistic regression for individual symptoms, health status, activity level, and missed work 3 and 6 months after COVID-19 illness, comparing each ethnicity or race to the referent group (non-Hispanic or white), adjusting for demographic factors, social determinants of health, substance use, pre-existing health conditions, SARS-CoV-2 infection status, COVID-19 vaccination status, and survey time point, with interactions between ethnicity or race and time point, ethnicity or race and SARS-CoV-2 infection status, and SARS-CoV-2 infection status and time point. Results Following SARS-CoV-2 infection, the majority of symptoms were similar over time between ethnic and racial groups. At 3 months, Hispanic participants were more likely than non-Hispanic participants to report fair/poor health (OR: 1.94; 95%CI: 1.36-2.78) and reduced activity (somewhat less, OR: 1.47; 95%CI: 1.06-2.02; much less, OR: 2.23; 95%CI: 1.38-3.61). At 6 months, differences by ethnicity were not present. At 3 months, Other/Multiple race participants were more likely than white participants to report fair/poor health (OR: 1.90; 95% CI: 1.25-2.88), reduced activity (somewhat less, OR: 1.72; 95%CI: 1.21-2.46; much less, OR: 2.08; 95%CI: 1.18-3.65). At 6 months, Asian participants were more likely than white participants to report fair/poor health (OR: 1.88; 95%CI: 1.13-3.12); Black participants reported more missed work (OR, 2.83; 95%CI: 1.60-5.00); and Other/Multiple race participants reported more fair/poor health (OR: 1.83; 95%CI: 1.10-3.05), reduced activity (somewhat less, OR: 1.60; 95%CI: 1.02-2.51; much less, OR: 2.49; 95%CI: 1.40-4.44), and more missed work (OR: 2.25; 95%CI: 1.27-3.98). Discussion Awareness of ethnic and racial differences in outcomes following SARS-CoV-2 infection may inform clinical and public health efforts to advance health equity in long-term outcomes.
Collapse
Affiliation(s)
- Kelli N. O’Laughlin
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Robin E. Klabbers
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Imtiaz Ebna Mannan
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - Nicole L. Gentile
- Department of Family Medicine, University of Washington, Seattle, WA, United States
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
- Post-COVID Rehabilitation and Recovery Clinic, University of Washington, Seattle, WA, United States
| | - Rachel E. Geyer
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Zihan Zheng
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Huihui Yu
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Shu-Xia Li
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - Kwun C. G. Chan
- Department of Biostatistics, University of Washington, Seattle, WA, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Erica S. Spatz
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
- Department of Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - Ralph C. Wang
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Michelle L’Hommedieu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Robert A. Weinstein
- Divisions of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
- Department of Medicine, Cook County Hospital, Chicago, IL, United States
| | - Ian D. Plumb
- National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Ryan M. Huebinger
- UTHealth Houston McGovern Medical School Department of Emergency Medicine, Houston, TX, United States
| | - Melissa Hagen
- National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Joann G. Elmore
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Mandy J. Hill
- UTHealth Houston McGovern Medical School Department of Emergency Medicine, Houston, TX, United States
| | - Morgan Kelly
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Samuel McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Kristin L. Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
- Center for Connected Care, Thomas Jefferson University, Philadelphia, PA, United States
| | - Robert M. Rodriguez
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Arjun Venkatesh
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Ahamed H. Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michelle Santangelo
- Divisions of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Katherine Koo
- Divisions of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Sharon Saydah
- National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Graham Nichol
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
| | - Kari A. Stephens
- Department of Family Medicine, University of Washington, Seattle, WA, United States
- Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
| | | |
Collapse
|
2
|
Ma KPK, Stephens KA, Geyer RE, Prado MG, Mollis BL, Zbikowski SM, Waters D, Masterson J, Zhang Y. Developing Digital Therapeutics for Chronic Pain in Primary Care: A Qualitative Human-Centered Design Study of Providers' Motivations and Challenges. JMIR Form Res 2023; 7:e41788. [PMID: 36735284 PMCID: PMC9938436 DOI: 10.2196/41788] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/10/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Digital therapeutics are growing as a solution to manage pain for patients; yet, they are underused in primary care where over half of the patients with chronic pain seek care. Little is known about how to successfully engage primary care providers in recommending digital therapeutics to their patients. Exploring provider motivations in chronic pain management would potentially help to improve their engagement and inform the development of digital therapeutics. OBJECTIVE This study examined primary care providers' motivations for chronic pain management, including their strategies and challenges, to inform the future development of chronic pain-related digital therapeutics tailored to primary care settings. METHODS We conducted qualitative semistructured interviews with health care providers recruited from 3 primary care clinics in Washington and 1 clinic in Colorado between July and October 2021. The sample (N=11) included 7 primary care physicians, 2 behavioral health providers, 1 physician assistant, and 1 nurse. Most providers worked in clinics affiliated with urban academic health systems. Guided by the human-centered design approach and Christensen's Job-to-be-Done framework, we asked providers their goals and priorities in chronic pain management, their experiences with challenges and strategies used to care for patients, and their perceptions of applying digital therapeutics in clinical practice. Transcripts were analyzed using a thematic analysis approach. RESULTS We found that primary care providers were motivated but challenged to strengthen the patient-provider alliance, provide team-based care, track and monitor patients' progress, and address social determinants of health in chronic pain management. Specifically, providers desired additional resources to improve patient-centered communication, pain education and counseling, and goal setting with patients. Providers also requested greater accessibility to multidisciplinary care team consultations and nonpharmacological pain treatments. When managing chronic pain at the population level, providers need infrastructure and systems to systematically track and monitor patients' pain and provide wraparound health and social services for underserved patients. Recommendations on digital therapeutic features that might address provider challenges in achieving these motivations were discussed. CONCLUSIONS Given the findings, to engage primary care providers, digital therapeutics for chronic pain management need to strengthen the patient-provider alliance, increase access to nonpharmacological treatment options, support population health tracking and management, and provide equitable reach. Leveraging digital therapeutics in a feasible, appropriate, and acceptable way to aid primary care providers in chronic pain management may require multimodal features that address provider motivations at an individual care and clinic or system level.
Collapse
Affiliation(s)
- Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Kari A Stephens
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Rachel E Geyer
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Maria G Prado
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Brenda L Mollis
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | | | | | | | - Ying Zhang
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| |
Collapse
|
3
|
Gentsch AT, Butler J, O'Laughlin K, Eucker SA, Chang A, Duber H, Geyer RE, Guth A, Kanzaria HK, Pauley A, Rising KL, Chavez CL, Tupetz A, Rodriguez RM. Perspectives of COVID-19 vaccine-hesitant emergency department patients to inform messaging platforms to promote vaccine uptake. Acad Emerg Med 2023; 30:32-39. [PMID: 36310395 PMCID: PMC9874774 DOI: 10.1111/acem.14620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Efforts to promote COVID-19 vaccine acceptance must consider the critical role of the emergency department (ED) in providing health care to underserved patients. Focusing on patients who lacked primary care, we sought to elicit the perspectives of unvaccinated ED patients regarding COVID-19 vaccination concerns and potential approaches that might increase their vaccine acceptance. METHODS We conducted this qualitative interview study from August to November 2021 at four urban EDs in San Francisco, California; Seattle, Washington; Durham, North Carolina; and Philadelphia, Pennsylvania. We included ED patients who were ≥18 years old, fluent in English or Spanish, had not received a COVID-19 vaccine, and did not have primary care physicians or clinics. We excluded patients who were unable to complete an interview, in police custody, under suspicion of active COVID-19 illness, or presented with a psychiatric chief complaint. We enrolled until we reached thematic saturation in relevant domains. We analyzed interview transcripts with a content analysis approach focused on identifying concerns about COVID-19 vaccines and ideas regarding the promotion of vaccine acceptance and potential trusted messengers. RESULTS Of 65 patients enrolled, 28 (43%) identified as female, their median age was 36 years (interquartile range 29-49), and 12 (18%) interviews were conducted in Spanish. Primary concerns about COVID-19 vaccines included risk of complications, known and unknown side effects, and fear of contracting COVID-19 from vaccines. Trust played a major role for patients in deciding which sources to use for vaccine information and in engendering vaccine acceptance. Health care providers and family or friends were commonly cited as trusted messengers of information. CONCLUSIONS We characterized concerns about COVID-19 vaccines, uncovered themes that may promote vaccine acceptance, and identified trusted messengers-primarily health care professionals. These data may inform the development of nuanced COVID-19 vaccine messaging platforms to address COVID-19 vaccine hesitancy among underserved ED populations.
Collapse
Affiliation(s)
- Alexzandra T Gentsch
- Center for Connected Care, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jonathan Butler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Kelli O'Laughlin
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Stephanie A Eucker
- Department of Emergency Medicine, Duke University, Durham, North Carolina, USA
| | - AnnaMarie Chang
- Center for Connected Care, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Herbie Duber
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Rachel E Geyer
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Amanda Guth
- Center for Connected Care, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Hemal K Kanzaria
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Alena Pauley
- Department of Emergency Medicine, Duke University, Durham, North Carolina, USA
| | - Kristin L Rising
- Center for Connected Care, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Cecilia Lara Chavez
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Anna Tupetz
- Department of Emergency Medicine, Duke University, Durham, North Carolina, USA
| | - Robert M Rodriguez
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
4
|
Cai X, Ebell MH, Geyer RE, Thompson M, Gentile NL, Lutz B. The impact of a rapid home test on telehealth decision-making for influenza: a clinical vignette study. BMC Prim Care 2022; 23:75. [PMID: 35418027 PMCID: PMC9006488 DOI: 10.1186/s12875-022-01675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/27/2022] [Indexed: 10/28/2022]
Abstract
Abstract
Background
Home testing for influenza has the potential to aid triage and management decisions for patients with influenza-like illness. As yet, little is known about the effect of the home influenza testing on clinical decision-making via telehealth. The goal of this study was to determine the clinicians’ decision thresholds for influenza and whether the availability of a home influenza test affects clinical decisions.
Methods
We identified primary care physicians at 4 different sites in the US, largely via in-person continuing education meetings. Clinicians were asked for each vignette whether to treat empirically (“rule in”), ask the patient come to the clinic for further evaluation (“test”), or neither test nor treat (“rule out”). They were then given the results of a home influenza test, and were again asked to select from these three options. We measured the agreement of physician estimates of the likelihood of influenza with the probability based on a clinical prediction model. The test and treatment thresholds of influenza were determined based on mixed-effect logistic regressions.
Results
In total, 202 clinicians made 570 sets of clinical decisions. Agreement between estimated and actual probability of influenza was fair. The test and treatment thresholds were 24% (95% CI: 22% to 25%) and 63% (95% CI: 58% to 65%) before revealing the actual likelihood of influenza. After providing the results of a home flu test the thresholds were similar, 26% (95% CI: 24% to 29%) and 59% (95% CI: 56% to 62%). However, approximately half of clinicians changed their cliical management decision after being given the home influenza test result, largely by categorizing more patients in the “rule out” and “rule in” groups, and reducing the need for in-person evaluation from 41% of patients to only 20%.
Conclusion
In the context of a telehealth visit for a patient with influenza-like illness, we identified a test threshold of approximately 25% and a treatment threshold of approximately 60%. Adding the home influenza test results reduced uncertainty and significantly decreased the need for in-person visits.
Collapse
|
5
|
Geyer RE, Kotnik JH, Lyon V, Brandstetter E, Zigman Suchsland M, Han PD, Graham C, Ilcisin M, Kim AE, Chu HY, Nickerson DA, Starita LM, Bedford T, Lutz B, Thompson MJ. Diagnostic Accuracy of an At-Home, Rapid Self-test for Influenza: Prospective Comparative Accuracy Study. JMIR Public Health Surveill 2022; 8:e28268. [PMID: 35191852 PMCID: PMC8905479 DOI: 10.2196/28268] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 11/02/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Rapid diagnostic tests (RDTs) for influenza used by individuals at home could potentially expand access to testing and reduce the impact of influenza on health systems. Improving access to testing could lead to earlier diagnosis following symptom onset, allowing more rapid interventions for those who test positive, including behavioral changes to minimize spread. However, the accuracy of RDTs for influenza has not been determined in self-testing populations. Objective This study aims to assess the accuracy of an influenza RDT conducted at home by lay users with acute respiratory illness compared with that of a self-collected sample by the same individual mailed to a laboratory for reference testing. Methods We conducted a comparative accuracy study of an at-home influenza RDT (Ellume) in a convenience sample of individuals experiencing acute respiratory illness symptoms. Participants were enrolled in February and March 2020 from the Greater Seattle region in Washington, United States. Participants were mailed the influenza RDT and reference sample collection materials, which they completed and returned for quantitative reverse-transcription polymerase chain reaction influenza testing in a central laboratory. We explored the impact of age, influenza type, duration, and severity of symptoms on RDT accuracy and on cycle threshold for influenza virus and ribonuclease P, a marker of human DNA. Results A total of 605 participants completed all study steps and were included in our analysis, of whom 87 (14.4%) tested positive for influenza by quantitative reverse-transcription polymerase chain reaction (70/87, 80% for influenza A and 17/87, 20% for influenza B). The overall sensitivity and specificity of the RDT compared with the reference test were 61% (95% CI 50%-71%) and 95% (95% CI 93%-97%), respectively. Among individuals with symptom onset ≤72 hours, sensitivity was 63% (95% CI 48%-76%) and specificity was 94% (95% CI 91%-97%), whereas, for those with duration >72 hours, sensitivity and specificity were 58% (95% CI 41%-74%) and 96% (95% CI 93%-98%), respectively. Viral load on reference swabs was negatively correlated with symptom onset, and quantities of the endogenous marker gene ribonuclease P did not differ among reference standard positive and negative groups, age groups, or influenza subtypes. The RDT did not have higher sensitivity or specificity among those who reported more severe illnesses. Conclusions The sensitivity and specificity of the self-test were comparable with those of influenza RDTs used in clinical settings. False-negative self-test results were more common when the test was used after 72 hours of symptom onset but were not related to inadequate swab collection or severity of illness. Therefore, the deployment of home tests may provide a valuable tool to support the management of influenza and other respiratory infections.
Collapse
Affiliation(s)
- Rachel E Geyer
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Jack Henry Kotnik
- Department of Family Medicine, University of Washington, Seattle, WA, United States.,Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Victoria Lyon
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Elisabeth Brandstetter
- Department of Medicine, University of Washington, Seattle, WA, United States.,Brotman Baty Institute, University of Washington, Seattle, WA, United States
| | | | - Peter D Han
- Brotman Baty Institute, University of Washington, Seattle, WA, United States.,Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Chelsey Graham
- Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Misja Ilcisin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Ashley E Kim
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle, WA, United States.,Brotman Baty Institute, University of Washington, Seattle, WA, United States
| | - Deborah A Nickerson
- Brotman Baty Institute, University of Washington, Seattle, WA, United States.,Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Lea M Starita
- Brotman Baty Institute, University of Washington, Seattle, WA, United States.,Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Trevor Bedford
- Brotman Baty Institute, University of Washington, Seattle, WA, United States.,Department of Genome Sciences, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Barry Lutz
- Department of Bioengineering, University of Washington, Seattle, WA, United States.,Brotman Baty Institute, University of Washington, Seattle, WA, United States
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| |
Collapse
|
6
|
Srivatsan S, Heidl S, Pfau B, Martin BK, Han PD, Zhong W, van Raay K, McDermot E, Opsahl J, Gamboa L, Smith N, Truong M, Cho S, Barrow KA, Rich LM, Stone J, Wolf CR, McCulloch DJ, Kim AE, Brandstetter E, Sohlberg SL, Ilcisin M, Geyer RE, Chen W, Gehring J, Kosuri S, Bedford T, Rieder MJ, Nickerson DA, Chu HY, Konnick EQ, Debley JS, Shendure J, Lockwood CM, Starita LM. SwabExpress: An end-to-end protocol for extraction-free covid-19 testing. Clin Chem 2021; 68:143-152. [PMID: 34286830 DOI: 10.1093/clinchem/hvab132] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND The urgent need for massively scaled clinical testing for SARS-CoV-2, along with global shortages of critical reagents and supplies, has necessitated development of streamlined laboratory testing protocols. Conventional nucleic acid testing for SARS-CoV-2 involves collection of a clinical specimen with a nasopharyngeal swab in transport medium, nucleic acid extraction, and quantitative reverse transcription PCR (RT-qPCR) (1). As testing has scaled across the world, the global supply chain has buckled, rendering testing reagents and materials scarce (2). To address shortages, we developed SwabExpress, an end-to-end protocol developed to employ mass produced anterior nares swabs and bypass the requirement for transport media and nucleic acid extraction. METHODS We evaluated anterior nares swabs, transported dry and eluted in low-TE buffer as a direct-to-RT-qPCR alternative to extraction-dependent viral transport media. We validated our protocol of using heat treatment for viral inactivation and added a proteinase K digestion step to reduce amplification interference. We tested this protocol across archived and prospectively collected swab specimens to fine-tune test performance. RESULTS After optimization, SwabExpress has a low limit of detection at 2-4 molecules/uL, 100% sensitivity, and 99.4% specificity when compared side-by-side with a traditional RT-qPCR protocol employing extraction. On real-world specimens, SwabExpress outperforms an automated extraction system while simultaneously reducing cost and hands-on time. CONCLUSION SwabExpress is a simplified workflow that facilitates scaled testing for COVID-19 without sacrificing test performance. It may serve as a template for the simplification of PCR-based clinical laboratory tests, particularly in times of critical shortages during pandemics.
Collapse
Affiliation(s)
- Sanjay Srivatsan
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Sarah Heidl
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Brian Pfau
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Beth K Martin
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Peter D Han
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Weizhi Zhong
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | | | - Evan McDermot
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Jordan Opsahl
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Luis Gamboa
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Nahum Smith
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Melissa Truong
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Shari Cho
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Kaitlyn A Barrow
- Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, WA, USA
| | - Lucille M Rich
- Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, WA, USA
| | - Jeremy Stone
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Caitlin R Wolf
- Department of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Denise J McCulloch
- Department of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Ashley E Kim
- Department of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | | | - Sarah L Sohlberg
- Department of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Misja Ilcisin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rachel E Geyer
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Wei Chen
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Jase Gehring
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | | | - Sriram Kosuri
- Octant, Inc. Emeryville CA, USA.,Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Trevor Bedford
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.,Brotman Baty Institute For Precision Medicine, Seattle, WA, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mark J Rieder
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Deborah A Nickerson
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.,Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| | - Helen Y Chu
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA.,Department of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Eric Q Konnick
- Brotman Baty Institute For Precision Medicine, Seattle, WA, USA.,Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Jason S Debley
- Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, WA, USA
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.,Brotman Baty Institute For Precision Medicine, Seattle, WA, USA.,Howard Hughes Medical Institute. Seattle, WA, USA
| | - Christina M Lockwood
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.,Brotman Baty Institute For Precision Medicine, Seattle, WA, USA.,Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Lea M Starita
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.,Brotman Baty Institute For Precision Medicine, Seattle, WA, USA
| |
Collapse
|
7
|
Srivatsan S, Heidl S, Pfau B, Martin BK, Han PD, Zhong W, van Raay K, McDermot E, Opsahl J, Gamboa L, Smith N, Truong M, Cho S, Barrow KA, Rich LM, Stone J, Wolf CR, McCulloch DJ, Kim AE, Brandstetter E, Sohlberg SL, Ilcisin M, Geyer RE, Chen W, Gehring J, Kosuri S, Bedford T, Rieder MJ, Nickerson DA, Chu HY, Konnick EQ, Debley JS, Shendure J, Lockwood CM, Starita LM. SwabExpress: An end-to-end protocol for extraction-free COVID-19 testing. bioRxiv 2021:2020.04.22.056283. [PMID: 32511368 PMCID: PMC7263496 DOI: 10.1101/2020.04.22.056283] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The urgent need for massively scaled clinical testing for SARS-CoV-2, along with global shortages of critical reagents and supplies, has necessitated development of streamlined laboratory testing protocols. Conventional nucleic acid testing for SARS-CoV-2 involves collection of a clinical specimen with a nasopharyngeal swab in transport medium, nucleic acid extraction, and quantitative reverse transcription PCR (RT-qPCR) (1). As testing has scaled across the world, the global supply chain has buckled, rendering testing reagents and materials scarce (2). To address shortages, we developed SwabExpress, an end-to-end protocol developed to employ mass produced anterior nares swabs and bypass the requirement for transport media and nucleic acid extraction. METHODS We evaluated anterior nares swabs, transported dry and eluted in low-TE buffer as a direct-to-RT-qPCR alternative to extraction-dependent viral transport media. We validated our protocol of using heat treatment for viral activation and added a proteinase K digestion step to reduce amplification interference. We tested this protocol across archived and prospectively collected swab specimens to fine-tune test performance. RESULTS After optimization, SwabExpress has a low limit of detection at 2-4 molecules/uL, 100% sensitivity, and 99.4% specificity when compared side-by-side with a traditional RT-qPCR protocol employing extraction. On real-world specimens, SwabExpress outperforms an automated extraction system while simultaneously reducing cost and hands-on time. CONCLUSION SwabExpress is a simplified workflow that facilitates scaled testing for COVID-19 without sacrificing test performance. It may serve as a template for the simplification of PCR-based clinical laboratory tests, particularly in times of critical shortages during pandemics.
Collapse
Affiliation(s)
- Sanjay Srivatsan
- Department of Genome Sciences, University of Washington, Seattle WA, USA
| | - Sarah Heidl
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Brian Pfau
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Beth K. Martin
- Department of Genome Sciences, University of Washington, Seattle WA, USA
| | - Peter D. Han
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Weizhi Zhong
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | | | - Evan McDermot
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Jordan Opsahl
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Luis Gamboa
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Nahum Smith
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Melissa Truong
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Shari Cho
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Kaitlyn A. Barrow
- Center for Immunity and Immunotherapies, Seattle Children’s Research Institute, Seattle WA, USA
| | - Lucille M. Rich
- Center for Immunity and Immunotherapies, Seattle Children’s Research Institute, Seattle WA, USA
| | - Jeremy Stone
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Caitlin R. Wolf
- Department of Allergy and Infectious Disease, University of Washington, Seattle WA, USA
| | - Denise J. McCulloch
- Department of Allergy and Infectious Disease, University of Washington, Seattle WA, USA
| | - Ashley E. Kim
- Department of Allergy and Infectious Disease, University of Washington, Seattle WA, USA
| | | | - Sarah L. Sohlberg
- Department of Allergy and Infectious Disease, University of Washington, Seattle WA, USA
| | - Misja Ilcisin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rachel E. Geyer
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Wei Chen
- Department of Genome Sciences, University of Washington, Seattle WA, USA
| | - Jase Gehring
- Department of Genome Sciences, University of Washington, Seattle WA, USA
| | | | - Sriram Kosuri
- Octant, Inc. Emeryville CA, USA
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles CA, USA
| | - Trevor Bedford
- Department of Genome Sciences, University of Washington, Seattle WA, USA
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mark J. Rieder
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Deborah A. Nickerson
- Department of Genome Sciences, University of Washington, Seattle WA, USA
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| | - Helen Y. Chu
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- Department of Allergy and Infectious Disease, University of Washington, Seattle WA, USA
| | - Eric Q. Konnick
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- Department of Laboratory Medicine and Pathology, Seattle WA, USA
| | - Jason S. Debley
- Center for Immunity and Immunotherapies, Seattle Children’s Research Institute, Seattle WA, USA
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle WA, USA
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- Howard Hughes Medical Institute. Seattle WA, USA
| | - Christina M. Lockwood
- Department of Genome Sciences, University of Washington, Seattle WA, USA
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
- Department of Laboratory Medicine and Pathology, Seattle WA, USA
| | - Lea M. Starita
- Department of Genome Sciences, University of Washington, Seattle WA, USA
- Brotman Baty Institute For Precision Medicine, Seattle WA, USA
| |
Collapse
|
8
|
Geyer RE, Ibikounlé M, Emmanuel-Fabula M, Roll A, Avokpaho E, Elijan A, Wèkè LC, Togbevi CI, Chabi F, Houngbégnon P, Luty AJF, Yard E, Walson JL, Graham S, Means AR. Gender norms and mass deworming program access in Comé, Benin: A qualitative assessment of gender-associated opportunities and challenges to achieving high mass drug administration coverage. PLoS Negl Trop Dis 2020; 14:e0008153. [PMID: 32302298 PMCID: PMC7164589 DOI: 10.1371/journal.pntd.0008153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/19/2020] [Indexed: 12/03/2022] Open
Abstract
The World Health Organization’s Neglected Tropical Disease Roadmap has accelerated progress towards eliminating select neglected tropical diseases (NTDs). This momentum has catalyzed research to determine the feasibility of interrupting transmission of soil-transmitted helminths (STH) using community-wide mass drug administration (MDA). This study aims to identify potential gender-specific facilitators and barriers to accessing and participating in community-wide STH MDA, with the goal of ensuring programs are equitable and maximize the probability of interrupting STH transmission. This research was conducted prior to the launch of community-wide MDA for STH in Comé, Benin. A total of 10 focus group discussions (FGDs) were conducted separately among 40 men, 38 women, and 15 community drug distributors (CDDs). Salient themes included: both men and women believe that community-wide MDA would reduce the financial burden associated with self-treatment, particularly for low income adults. Community members believe MDA should be packaged alongside water, sanitation, and other health services. Women feel past community-wide programs have been disorganized and are concerned these distributions will be similar. Women also expressed interest in increased engagement in the implementation of future community-based public health programs. Men often did not perceive themselves to be at great risk for STH infection and did not express a high demand for treatment. Finally, the barriers discussed by CDDs generally did not align with gender-specific concerns, but rather represented concerns shared by both genders. A door-to-door distribution strategy for STH MDA is preferred by women in this study, as this platform empowers women to participate as health decision makers for their family. In addition, involving women in planning and implementation of community-wide programs may help to increase treatment coverage and compliance. Soil-transmitted helminths (STH) affect an estimated 1.5 billion people globally. The DeWorm3 Project is investigating if it is possible to interrupt transmission of STH with community-wide deworming of individuals of all ages. We conducted focus group discussions with adult men, women, and community drug distributors (CDDs) in Comé, Benin to identify gender-specific facilitators and barriers to accessing and participating in community-wide mass drug administration (MDA) programs. Our findings suggest that door-to-door community-wide MDA may not only improve MDA treatment coverage by increasing access but may also empower women by facilitating increased decision making on behalf of their regarding who is treated and where. Additionally, women may be an untapped resource for strategically reaching missed populations and women reported seeking increased involvement within the deworming of their families. Men did not perceive themselves to be at risk and thus did not have high demand for deworming. Both genders reported that they struggle to afford deworming drugs outside of MDA and that MDA coverage would be higher if treatment was integrated with water and sanitation services. Finally, CDDs generally identified only barriers and facilitators to MDA that were shared by both genders and may require more training to ensure MDA programs are equitable and effectively engage all at risk populations.
Collapse
Affiliation(s)
- Rachel E. Geyer
- Department of Global Health, University of Washington, Seattle, United States of America
- * E-mail:
| | - Moudachirou Ibikounlé
- Département de Zoologie, Faculté des Sciences et Techniques, Université d’Abomey-Calavi 01BP526, Cotonou, Benin
- Institute de Recherche Clinique du Bénin, Cotonou, Benin
| | - Mira Emmanuel-Fabula
- Department of Global Health, University of Washington, Seattle, United States of America
| | - Amy Roll
- Department of Global Health, University of Washington, Seattle, United States of America
| | | | - Abiguel Elijan
- Institute de Recherche Clinique du Bénin, Cotonou, Benin
| | | | | | - Félicien Chabi
- Institute de Recherche Clinique du Bénin, Cotonou, Benin
| | | | | | - Elodie Yard
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, United States of America
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Susan Graham
- Department of Global Health, University of Washington, Seattle, United States of America
- Department of Medicine, University of Washington, Seattle, United States of America
- Department of Epidemiology, University of Washington, Seattle, United States of America
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, United States of America
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| |
Collapse
|
9
|
Geyer RE. Extralabel drug use and compounding in veterinary medicine. Food Drug Law J 1997; 52:291-295. [PMID: 10343027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- R E Geyer
- Office of Surveillance and Compliance, Center for Veterinary Medicine, Food and Drug Administration, USA
| |
Collapse
|
10
|
Geyer RE. Legal restrictions on compounding. J Am Vet Med Assoc 1994; 205:241-2. [PMID: 7928588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- R E Geyer
- Office of Surveillance and Compliance, FDA/Center for Veterinary Medicine, Rockville, MD 20855
| |
Collapse
|
11
|
Geyer RE. Implications for the FDA/Center for Veterinary Medicine (CVM). J Am Vet Med Assoc 1993; 202:1718-23. [PMID: 8514592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- R E Geyer
- Office of Surveillance and Compliance, FDA/CVM, Rockville, MD 20855
| |
Collapse
|
12
|
Geyer RE. Meeting the educational needs of future animal science students. J Anim Sci 1969; 29:259-62. [PMID: 5361541 DOI: 10.2527/jas1969.292259x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
|