COVID-19 self-testing, a way to “live side by side with the coronavirus”: Results from a qualitative study in Indonesia

Abstract

Alongside mass vaccination for COVID-19, sustainable diagnostic strategies for SARS-CoV-2 are needed to empower local communities and help them complement health authorities’ efforts to end the pandemic in low- and middle-income countries. Indonesia is among the nations with an overstretched health system that may benefit from technological innovations, such as rapid SARS-CoV-2 antigen-detection tests for self-testing, to detect asymptomatic cases and interrupt the transmission of the virus to healthy individuals. In mid-2021, we conducted a qualitative research study with the aim of understanding key decision-makers’ values and preferences regarding the implementation of COVID-19 self-testing in Indonesia. This research received ethics approval from the Universitas Katolik Indonesia Atma Jaya and used a thematic analysis approach to explore the insights expressed by healthcare workers, representatives of civil society, and potential self-testing implementers in three geographies: Jakarta, Banten, and North Sulawesi. Thirty semi-structured interviews and six focus group discussions were carried out. As per the informants’ narratives, the Indonesian public might accept rapid SARS-CoV-2 antigen-detection self-testing as a tool that will enable them to test for COVID-19 at their own convenience. Concerns were expressed that the public might doubt the reliability of self-testing kits if these were not properly regulated and if counterfeit kits were known to be on the market. Fear of stigma, isolation, and clinical care costs were perceived to be among the drivers for self-test users to not report a reactive result. These fears might be mitigated, as per the informants’ opinions, by awareness raising, passing of regulations, and participatory engagement of a range of community actors, such as village officers. Decision-makers consider rapid SARS-CoV-2 antigen-detection self-testing to be a welcomed screening tool that could contribute to ensuring earlier access to treatment and decrease transmission of SARS-CoV-2 in Indonesia.

Rapid SARS-CoV-2 Antigen Detection Self-Tests to Increase COVID-19 Case Detection in Peru: Qualitative Study

“…In the informants' opinion, if self-test devices had a price of between US $5.00 and US $10.00, the public might find this cost acceptable. These findings are aligned with the results of other qualitative studies into self-testing conducted in low-and middle-income settings, such as Indonesia [16] and South Africa [17]. Additionally, in 2 population-based surveys conducted in parallel with our qualitative study, in Kenya [18] and Indonesia [19], 81.4% and 60.8%, respectively, of the general public expressed a willingness to use self-testing, and 63.0% and 62.1%, respectively, expressed a willingness to pay for a self-test device.…”

COVID-19 self-testing in Nigeria: Stakeholders’ opinions and perspectives on its value for case detection

“…Such support might include sustained social protection services such as cash transfers, food vouchers and subsidised utilities for families and individuals whose sources of income risk being disrupted due to self-isolation. The same types of support measures from authorities to individuals self-isolating after receiving a reactive self-test result were also reported in the self-testing acceptability study carried out in Indonesia [ 30 ].…”

“…This is a concern for many cisgender men who are burdened with the need to provide care for their family as the sole breadwinner in many households, as well as for many cisgender women who work in the informal economy and rely on their daily wages to provide for their children [ 51 ]. The potential impact of isolation among sexual and gender minorities was not discussed in our study, however there is evidence from Indonesia [ 30 ] or the United States [ 52 ] that these minorities may face considerable socio-economic constraints to cope with isolation. The impact in children was also not discussed by our study informants.…”

“…During the first year of the COVID-19 pandemic, the Nigerian healthcare system was overburdened by financial, human resources, and testing supply shortages [ 28 , 29 ]. While plans must be instituted to accommodate a likely increase in the number of self-testers that may visit their nearest clinic requesting confirmatory testing, these informants’ opinions about the potential of self-testing to alleviate the burden on the healthcare system were shared by decision-takers who participated in a similar self-testing acceptability study in Indonesia [ 30 ]. To address potential increases of asymptomatic self-test users’ requests of confirmatory testing, it may be recommended that users interpret a reactive self-test result as a positive diagnosis of SARS-CoV-2 infection.…”

Self-tests for COVID-19: What is the evidence? A living systematic review and meta-analysis (2020–2023)

“…COVIDST facilitators assessed in twelve studies included self-test training prior to use, non-intrusive and ease of testing at-home, increased sense of safety, detailed self-test instructions, faster turnaround time, and instructional videos [23,28,32,57,61,62,66,68,70,[75][76][77][78][79].…”