Feasibility and Acceptability of Community Coronavirus Disease 2019 Testing Strategies (FACTS) in a University Setting

Abstract

Background During the COVID-19 pandemic in 2020, the UK government began a mass SARS-CoV-2 testing programme. This study aimed to determine the feasibility and acceptability of organised regular self-testing for SARS-CoV-2. Methods This was a mixed methods observational cohort study in asymptomatic students and staff at University of Oxford, who performed SARS-CoV-2 antigen lateral flow self-testing. Data on uptake and adherence, acceptability, and test interpretation were collected via a smartphone app, an online survey, and qualitative interviews. Findings Across three main sites, 551 participants (25% of those invited) performed 2728 tests during a follow-up of 5.6 weeks. 447 participants (81%) completed at least two, and 340 (62%) completed at least four tests. The survey, completed by 214 participants (39%), found that 98% of people were confident to self-test and believed self-testing to be beneficial. Acceptability of self-testing was high, with 91% of ratings being acceptable or very acceptable. 2711 (99.4%) test results were negative, nine were positive and eight were inconclusive. Results from eighteen qualitative interviews with students and staff revealed that participants valued regular testing, but there were concerns about test accuracy that impacted uptake and adherence. Interpretation This is the first study to assess feasibility and acceptability of regular SARS-CoV-2 self-testing. It provides evidence to inform recruitment, adherence to, and acceptability of regular SARS-CoV-2 self-testing programmes for asymptomatic individuals using lateral flow tests. We found that self-testing is acceptable and people were able to interpret results accurately. Funding This work was funded by Oxford University Medical Science Divisions

The clinical utility and epidemiological impact of self-testing for SARS-CoV-2 using antigen detecting diagnostics: a systematic review and meta-analysis

“…This is not surprising, as health care workers are likely experienced with COVID-19 testing and their frequent contact with vulnerable populations might foster their motivation to test [44]. In contrast, self-testing uptake was lowest (25.8%) among university students and staff [16]. However, certain operational barriers might have also limited uptake in this study.…”

“…All were in settings where no dedicated testing was performed before. The meta-analyzed proportion of positive test results was 0.2%(95% CI 0.1% to 0.4%) [15,16,29,31,32,34]. Test positivity ranged from 0.7% in the general population of a large city in the UK (Liverpool) [15] to 0.0% in university-wide screening, also in the UK [16] (Fig 2).…”

“…Moreover, studies have shown Ag-RDTs to be similarly accurate when performed by lay users or medically-trained persons [13]. Consequently, Ag-RDTs have already been applied in multiple settings as a tool for COVID-19 self-testing (C19ST) [14][15][16][17]. By increasing available testing capacity, C19ST using antigen-detection diagnostics could be an additional tool for pandemic control if implemented at scale [18,19].…”

“…Linkage for positive tests: Actions after a positive test result were reported in 11 datasets across two different settings. In nine data sets, positive results in mostly asymptomatic people required isolation (eight data sets) [16,17,29,31] or an invitation to seek confirmatory rRT-PCR testing (one data set) [15]. Second, in two datasets, positive test results of contacts already in quarantine required isolation [15,28].…”

Exploration of the uptake of asymptomatic COVID-19 lateral flow testing in Birmingham, UK: survey and qualitative research

“…The survey and interviews demonstrate population awareness that LFTs do not have equivalent test accuracy properties to PCR testing. Other studies examining perspectives on LFT accuracy also demonstrate that individuals give varied estimates of the accuracy of these tests11 or express uncertainty about their accuracy 12 13. In a study of care home staff experiences of integrating LFTs in routine practice participants were worried about the implications of inaccurate results such as false positives 14.…”