SARS-CoV-2 Testing Service Preferences of Adults in the United States: Discrete Choice Experiment

Abstract

Background Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission. Objective This study aims to determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission. Methods We used a discrete choice experiment to assess preferences for SARS-CoV-2 test type, specimen type, testing venue, and results turnaround time. Participants (n=4793) from the US national longitudinal Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study completed our online survey from July 30 to September 8, 2020. We estimated the relative importance of testing method attributes and part-worth utilities of attribute levels, and simulated the uptake of an optimized testing scenario relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal swab in a provider’s office or urgent care clinic with results in >5 days. Results Test result turnaround time had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). In simulations, immediate or same-day test results, both PCR and serology, or oral specimens substantially increased testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same-day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test. Conclusions Testing strategies that offer both PCR and serology with noninvasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2.

Knowledge, Attitudes, and Behavior Related to COVID-19 Testing: A Rapid Scoping Review

“…Lateral flow testing is less widely represented in the evidence base and is more likely to feature in articles and preprints based on more recently collected data [ 22 , 38 ]. The characteristics of all studies included in the review are summarized in Table 1 [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 …”

“…In terms of public preferences around testing sites and locations, pilot studies and service evaluation studies that asked about the convenience of their testing sites reported high levels of satisfaction across a range of testing venues and locations. These included home testing, drive-thru, walk-through, community testing, workplace, and campus testing [ 21 , 25 , 41 , 62 , 63 , 64 ]. A minor concern for participants in some studies was the fear of contracting the virus at the testing center [ 24 , 48 ].…”

“…Several studies found that the convenience and comfort of the sample extraction method affected willingness to test: participants found multiple options (cheek swab or spit, pharyngeal swab, nasopharyngeal swab, finger prick, dried blood spot card) acceptable, but overall preferred less invasive sampling methods [ 25 , 62 , 63 , 64 , 65 ]. Experience of physical discomfort while undergoing testing, especially nasopharyngeal swabbing, was widely reported [ 22 , 35 , 37 , 43 , 62 ], with one study suggesting that the deep nasopharyngeal swabbing method could act as a possible deterrent [ 62 ]. This reason was given by 10 out of the 16 patients who declined a test in a survey of patients in a US delivery unit conducted in May and June 2020 (n = 270) [ 43 ].…”

“…Negative perceptions of test-to-result turnaround times were a focus of three studies [ 47 , 50 , 62 ], with one US survey (n = 1221) in July and August 2020 finding that ‘time delays created a perception that testing was futile’ [ 50 ] (p. 5). Conversely, a survey across 16 Latin American countries (n = 5504) in March and April 2020 found that people valued longer waiting times (at least in theory), possibly associating them with more accurate types of tests [ 66 ], while some participants in a UK study ‘interpreted a longer wait as being suggestive of a positive result’ [ 25 ] (p. 5).…”

Mixed-methods Process Evaluation of a Residence-based SARS-CoV-2 Testing Participation Pilot on a UK University Campus during the COVID-19 Pandemic

“…Most of the student participants indicated they would take part again and would recommend the initiative to others. Students found the saliva test itself to be acceptable for regular testing; saliva testing for SARS-CoV-2 has been found to be a useful and acceptable tool for use in a mass screening context (Nacher et al, 2021;Tsang et al, 2021;Blake et al, 2020;Zimba et al, 2020).…”