Validating and modeling the impact of high-frequency rapid antigen screening on COVID-19 spread and outcomes

Nash, Beatrice; Badea, Anthony; Reddy, Ankita; Bosch, Miguel; Salcedo, Nol; Gómez, Antonio; Versiani, Alice F.; Silva, Gislaine Celestino Dutra; Santos, Thayza M. I. L. dos; Milhim, Bruno Henrique Gonçalves de Aguiar; Moraes, Marília Mazzi; Campos, Guilherme Rodrigues Fernandes; Quieroz, Flávia; Reis, Andréia Francesli Negri; Nogueira, Maurício Lacerda; Naumova, Elena N.; Bosch, Irene; Herrera, Bobby Brooke

doi:10.1101/2020.09.01.20184713

Cited by 15 publications

(14 citation statements)

References 55 publications

(65 reference statements)

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“…We show that it can, demonstrating this result within a individual-based network model that can be expected to provide qualitative insight. Our work supports the idea that population-level coverage is more important than test sensitivity, also pointing to a non-linear synergy between non-pharmaceutical interventions such as mandatory mask wearing, with testing accompanied by isolation and quarantine [54].…”

supporting

confidence: 83%

Optimizing testing for COVID-19 in India

Cherian

Krishna

Menon

2021

Preprint

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COVID-19 testing across India uses a mix of two types of tests. Rapid Antigen Tests (RATs) are relatively inexpensive point-of-care lateral-flow-assay tests, but they are also less sensitive. The reverse-transcriptase polymerase-chain-reaction (RT-PCR) test has close to 100% sensitivity and specificity in a laboratory setting, but delays in returning results, as well as increased costs relative to RATs, may vitiate this advantage.India-wide, about 49% of COVID-19 tests are RATs, but some Indian states, including the large states of Uttar Pradesh (pop. 227.9 million) and Bihar (pop. 121.3 million) use a much higher proportion of such tests. Here we show, using simulations based on epidemiological network models, that the judicious use of RATs can yield epidemiological outcomes comparable to those obtained through RT-PCR-based testing and isolation of positives, provided a few conditions are met. These are (a) that RAT test sensitivity is not too low, (b) that a reasonably large fraction of the population, of order 0.5% per day, can be tested, (c) that those testing positive are isolated for a sufficient duration, and that (d) testing is accompanied by other non-pharmaceutical interventions for increased effectiveness. We assess optimal testing regimes, taking into account test sensitivity and specificity, background seroprevalence and current test pricing. We find, surprisingly, that even 100% RAT test regimes should be acceptable, from both an epidemiological as well as a economic standpoint, provided the conditions outlined above are met.Author summaryUsing network models, we study optimal ways of combining low sensitivity, relatively inexpensive point-of-care rapid antigen tests for COVID-19 with higher sensitivity but more expensive laboratory RT-PCR tests. We take into account background seroprevalence and current test pricing for such tests in India, finding that even purely rapid antigen test-based regimes can produce the same reduction in overall infections that pure RT-PCR tests are capable of. This is provided one can test at scale and isolate those testing positive effectively, that the sensitivity of the rapid test is not too low and that non-pharmaceutical interventions proceed in parallel for increased effectiveness.

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supporting

confidence: 83%

Optimizing testing for COVID-19 in India

Cherian

Krishna

Menon

2021

Preprint

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“…One approach is the complementary use of the Ag-RDT with clinical diagnostic evaluations and another approach is the use of repeated testing 23 . A recent study using the enhanced epidemiological SIDHRE-Q model concluded that frequent Ag-RDT testing overcame the limitation of low test sensitivity, suggesting this might be an effective method to control SARS-CoV-2 transmission 24 . However, future research must confirm these findings in real-world settings, as not all diagnostic tests are useful for screening 25 .…”

Section: Resultsmentioning

confidence: 99%

Panbio™ rapid antigen test for SARS-CoV-2 has acceptable accuracy in symptomatic patients in primary health care

Bulilete

Lorente

Leiva

et al. 2021

Journal of Infection

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Objectives: We aimed to evaluate the accuracy of the Panbio TM Ag-RDT at primary health care (PHC) centers and test sites in symptomatic patients and close contacts, using the Reverse-Transcription Polymerase Chain Reaction (RT-PCR) test as the gold standard. Methods: The study was conducted in four PHC centers and two test sites in Mallorca, Spain. Consecutive patients older than 18 years, attending the sites for RT-PCR testing were included. Two nasopharyngeal samples were collected, one for RT-PCR and the other was processed on-site using the Panbio TM rapid antigen test kit for SARS-CoV-2. The sensitivity and specificity were calculated using RT-PCR as the reference, and the predictive values using the pretest probability results for each analyzed group. Findings: A total of 1369 participants were included; mean age 42.5 ± 14.9 years and 54.3% women. The overall prevalence was 10.2%. Most participants (70.6%) presented within 5 days of the onset of symptoms. The overall sensitivity was of 71.4% (95% CI: 63.1%, 78.7%), the specificity of 99.8% (95% CI: 99.4%, 99.9%), the positive predictive value of 98.0% (95% CI: 93.0%, 99.7%) and a negative predictive value of 96.8% (95% CI: 95.7%, 97.7%). The sensitivity was higher in symptomatic patients, in those arriving within 5 days since symptom onset and in those with high viral load. ✩ COVID-19 Primary Care Research Group members (alphabetical order) Layla Aoukhiyad-pharmacist,

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“…One approach is the complementary use of the Ag-RDT with clinical diagnostic evaluations and another approach is the use of repeated testing (23). A recent study using the enhanced epidemiological SIDHRE-Q model concluded that frequent Ag-RDT testing overcame the limitation of low test sensitivity, suggesting this might be an effective method to control SARS-CoV-2 transmission (24). However, future research must confirm these findings in real-world settings, as not all diagnostic tests are useful for screening(25).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Panbio™ rapid antigen test for SARS-CoV-2 in primary health care centers and test sites

Bulilete

Lorente

Leiva

et al. 2020

Preprint

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BackgroundRapid antigen tests (Ag-RDT) are emerging as new diagnostic tools for COVID-19 and real-world evaluations are needed to establish their performance characteristics.Main objectiveTo evaluate the accuracy of the Panbio™ Ag-RDT at primary health care (PHC) centers and test sites in symptomatic patients and close contacts, using the Reverse-Transcription Polymerase Chain Reaction (RT-PCR) test as the gold standard.MethodsThis was a prospective diagnostic study conducted in four PHC centers and two test sites in Mallorca, Spain. Consecutive patients older than 18 years, attending the sites for RT-PCR testing either for suggestive symptoms of infection or a close contact, were included. Two nasopharyngeal samples were collected, one for RT-PCR and the other was processed on-site using the Panbio™ rapid antigen test kit for SARS-CoV-2. The sensitivity and specificity were calculated using RT-PCR as the reference, and the predictive values using the pretest probability results for each analyzed group.ResultsA total of 1369 participants were included; mean age 42.5 ± 14.9 years and 54.3% women. The overall prevalence was 10.2%. Most participants (70.6%) presented within 5 days of the onset of symptoms or close contact, and more than 70% had high viral loads. The overall sensitivity was of 71.4% (95% CI: 63.1%, 78.7%), the specificity of 99.8% (95% CI: 99.4%, 99.9%), the positive predictive value of 98.0% (95% CI: 93.0%, 99.7%) and a negative predictive value of 96.8% (95% CI: 95.7%, 97.7%). The sensitivity was higher in symptomatic patients, in those arriving within 5 days since symptom onset and in those with high viral load.ConclusionAg-RDT had relatively good performance characteristics in suspected symptomatic patients within five days since the onset of symptoms. However, our results concludes that a negative Ag-RDT in these settings must be considered as presumptive.

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Validating and modeling the impact of high-frequency rapid antigen screening on COVID-19 spread and outcomes

Cited by 15 publications

References 55 publications

Optimizing testing for COVID-19 in India

Optimizing testing for COVID-19 in India

Panbio™ rapid antigen test for SARS-CoV-2 has acceptable accuracy in symptomatic patients in primary health care

Evaluation of the Panbio™ rapid antigen test for SARS-CoV-2 in primary health care centers and test sites

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