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Starke JC, Bell NS, Martinez CM, Friberg IK, Lawley C, Sriskantharajah V, Hirschberg DL. Measuring SARS-CoV-2 RNA concentrations in neighborhood wastewater. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 926:172021. [PMID: 38552966 DOI: 10.1016/j.scitotenv.2024.172021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
Longitudinal wastewater sampling during the COVID-19 pandemic was an important aspect of disease surveillance, adding to a more complete understanding of infection dynamics and providing important data for community public health monitoring and intervention planning. This was largely accomplished by testing SARS-CoV-2 RNA concentrations in samples from municipal wastewater treatment plants (WWTPs). We evaluated the utility of testing for virus levels upstream from WWTP within the residential neighborhoods that feed into the WWTP. We propose that monitoring virus dynamics across residential neighborhoods could reveal important public health-relevant information about community sub-group heterogeneity in virus concentrations. PRINCIPAL RESULTS: Virus concentration patterns display heterogeneity within neighborhoods and between neighborhoods over time. Sewage SARS-CoV-2 RNA concentrations as measured by RT-qPCR also corresponded closely to verified COVID-19 infection counts within individual neighborhoods. More importantly, our data suggest the loss of disease-relevant public health information when sampling occurs only at the level of WWTP instead of upstream in neighborhoods. Spikes in SARS-CoV-2 RNA concentrations in neighborhoods are often masked by dilution from other neighborhoods in the WWTP samples. MAJOR CONCLUSIONS: Wastewater-based epidemiology (WBE) employed at WWTP reliably detects SARS-CoV-2 in a city-sized population but provides less actionable public health information about neighborhoods experiencing greater viral infection and disease. Neighborhood sewershed sampling reveals important population-based information about local virus dynamics and improves opportunities for public health intervention. Longitudinally employed, neighborhood sewershed surveillance may provide a 3-6 day early warning of SARS-CoV-2 infection spikes and, importantly, highly specific information on subpopulations in a community particularly at higher risk at different points in time. Sampling in neighborhoods may thus provide timely and cost-saving information for targeted interventions within communities.
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Affiliation(s)
| | - Nicole S Bell
- RAIN Incubator, Tacoma, WA, USA; Squally Creek, LLC, Tacoma, WA, USA
| | - Chloe Mae Martinez
- RAIN Incubator, Tacoma, WA, USA; University of Washington-Tacoma, Tacoma, WA, USA
| | | | | | | | - David L Hirschberg
- RAIN Incubator, Tacoma, WA, USA; School of Engineering and Technology, University of Washington-Tacoma, Tacoma, WA, USA
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2
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D'Agostino EM, Rosenberg LM, Richmond A, Damman A, Brown-Lowery C, Abbot-Grimes P, Siddiqui S, Fadika T, Ward M, Cooper M, Sutton S, Kenton L, Spaziano B, Kasper J, Barnes N, Hornik CP. Enhancing Community Engagement in Research: A Tiered Approach. Am J Public Health 2024; 114:S372-S376. [PMID: 38776494 PMCID: PMC11111376 DOI: 10.2105/ajph.2024.307608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Emily M D'Agostino
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Lauren M Rosenberg
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Alan Richmond
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Allyn Damman
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Camille Brown-Lowery
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Princess Abbot-Grimes
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Saira Siddiqui
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Tigidankay Fadika
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Mark Ward
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Mia Cooper
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Sonya Sutton
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Lindsay Kenton
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Bob Spaziano
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Janet Kasper
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Nicole Barnes
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
| | - Christoph P Hornik
- Emily M. D'Agostino, Allyn Damman, Camille Brown-Lowery, Princess Abbot-Grimes, Saira Siddiqui, Tigidankay Fadika, Mark Ward, Mia Cooper, Sonya Sutton, Lindsay Kenton, Bob Spaziano, and Christoph P. Hornik are with the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Lauren M. Rosenberg is with the Duke Global Health Institute, Duke University School of Medicine, Durham, NC. Alan Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Janet Kasper is with the United Way of Merced County, Merced, CA. Nicole Barnes is with the Pitt County Health Department, Greenville, NC. Emily D'Agostino was also a Guest Editor for this supplemental issue
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3
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Cross LM, DeFosset A, Yusuf B, Conserve D, Anderson R, Carilli C, Kibbe W, Cohen-Wolkowiez M, Richmond A, Corbie G, Dave G. Exploring barriers and facilitators of implementing an at-home SARS-CoV-2 antigen self-testing intervention: The Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiatives. PLoS One 2023; 18:e0294458. [PMID: 37971996 PMCID: PMC10653400 DOI: 10.1371/journal.pone.0294458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Evaluating community-based programs provides value to researchers, funding entities, and community stakeholders involved in program implementation, and can increase program impact and sustainability. To understand factors related to program implementation, we aimed to capture the perspective of community partners engaged in organizing and executing community-engaged programs to distribute COVID-19 at-home tests in underserved communities. METHODS We conducted semi-structured interviews and focus groups with community-based stakeholders informed by the Outcomes for Implementation Research framework. RESULTS Findings describe how community-engaged communication and dissemination strategies drove program adoption among grassroots stakeholders. Establishing and sustaining trusted relationships was vital to engaging partners with aligned values and capacity. Respondents characterized the programs as generally feasible and appropriate, and community partners felt capable of delivering the program successfully. However, they also described an increased burden on their workforce and desired more significant support. Respondents recognized the programs' community engagement practices as a critical facilitator of acceptability and impact. DISCUSSION Implementation evaluation aims to inform current and future community outreach and engagement efforts with best practices. As we continue to inform and advance community-engaged disaster response practice, a parallel reimagining of public health funding mechanisms and timelines could provide a foundation for trust, collaboration, and community resiliency that endures beyond a given crisis.
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Affiliation(s)
- Lisa Maria Cross
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Amelia DeFosset
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Bola Yusuf
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Donaldson Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C, United States of America
| | - Rakiah Anderson
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Christina Carilli
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Warren Kibbe
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Alan Richmond
- Community-Campus Partnerships for Health, Raleigh, North Carolina, United States of America
| | - Giselle Corbie
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Gaurav Dave
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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4
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D'Agostino EM, Rosenberg LM, Richmond A, Damman A, Brown-Lowery C, Abbot-Grimes P, Siddiqui S, Fadika T, Ward M, Cooper M, Sutton S, Kenton L, Spaziano B, Kasper J, Barnes N, Hornik C. You & Me: Test and Treat study protocol for promoting COVID-19 test and treatment access to underserved populations. BMC Public Health 2023; 23:2121. [PMID: 37898741 PMCID: PMC10612258 DOI: 10.1186/s12889-023-16960-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Infections and deaths from the COVID-19 pandemic have disproportionately affected underserved populations. A community-engaged approach that supports decision making around safe COVID-19 practices is needed to promote equitable access to testing and treatment. You & Me: Test and Treat (YMTT) will evaluate a systematic and scalable community-engaged protocol that provides rapid access to COVID-19 at-home tests, education, guidance on next steps, and information on local resources to facilitate treatment in underserved populations. METHODS This direct-to-participant observational study will distribute at-home, self-administered, COVID-19 testing kits to people in designated communities. YMTT features a Public Health 3.0 framework and Toolkit prescribing a tiered approach to community engagement. We will partner with two large community organizations, Merced County United Way (Merced County, CA) and Pitt County Health Department (Pitt County, NC), who will coordinate up to 20 local partners to distribute 40,000 COVID tests and support enrollment, consenting, and data collection over a 15-month period. Participants will complete baseline questions about their demographics, experience with COVID-19 infection, and satisfaction with the distribution event. Community partners will also complete engagement surveys. In addition, participants will receive guidance on COVID-19 mitigation and health-promoting resources, and accessible and affordable therapeutics if they test positive for COVID-19. Data collection will be completed using a web-based platform that enables creation and management of electronic data capture forms. Implementation measures include evaluating 1) the Toolkit as a method to form community-academic partnerships for COVID-19 test access, 2) testing results, and 3) the efficacy of a YMTT protocol coupled with local resourcing to provide information on testing, guidance, treatment, and links to resources. Findings will be used to inform innovative methods to address community needs in public health research that foster cultural relevance, improve research quality, and promote health equity. DISCUSSION This work will promote access to COVID-19 testing and treatment for underserved populations by leveraging a community-engaged research toolkit. Future dissemination of the toolkit can support effective community-academic partnerships for health interventions in underserved settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05455190 . Registered 13 July 2022.
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Affiliation(s)
- Emily M D'Agostino
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
- Duke Global Health Institute, Duke University School of Medicine, Durham, NC, USA.
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Lauren M Rosenberg
- Duke Global Health Institute, Duke University School of Medicine, Durham, NC, USA
| | - Alan Richmond
- Community-Campus Partnerships for Health, Raleigh, NC, USA
| | - Allyn Damman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Camille Brown-Lowery
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Princess Abbot-Grimes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Saira Siddiqui
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Tigidankay Fadika
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Mark Ward
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Mia Cooper
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Sonya Sutton
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Lindsay Kenton
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Bob Spaziano
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Christoph Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
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5
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Green RK, Manchola C, Gerth-Guyette E, Oliveira Silva M, Stephanie R, dos Santos Soares T, Bastos Gottin L, Coelho M, Green KE, Dias Tavares Costa A, Batista Pereira D. Integration of serial self-testing for COVID-19 as part of contact tracing in the Brazilian public health system: A pragmatic trial protocol. PLoS One 2023; 18:e0284659. [PMID: 37792740 PMCID: PMC10550143 DOI: 10.1371/journal.pone.0284659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has led to an unprecedented public health crisis. Insufficient testing continues to limit the effectiveness of the global response to the COVID-19 pandemic. Molecular testing methods such as reverse transcriptase polymerase chain reaction (RT-PCR) continue to be highly centralized and are a sub-optimal option for population surveillance. Rapid antigen tests (Ag-RDTs) offer multiple benefits including low costs, high flexibility to conduct tests in a wide variety of settings, and faster return of results. Self-test Ag-RDTs (STs) have gained approval in several markets and offer the possibility to expand testing, reaching at-risk populations. While STs have the potential to assist the COVID-19 response, test result integrity, reporting, and appropriate linkage to care continue to hinder the widespread implementation of self-testing programs. This protocol presents a mixed-methods pragmatic trial (ISRCTN91602092) to better understand the feasibility of self-testing as part of a contact tracing strategy within the Brazilian public health system. Approximately 604 close contacts of 150 index cases testing positive for COVID-19 will be enrolled. Index cases will be randomized for their close contacts to participate in either serial (daily) self-testing over a 10-day follow-up period or a more traditional approach to contact tracing with a professional Ag-RDT at one time point post-exposure. Usability workshops and focus group discussions will also be conducted. This study protocol presents a comprehensive plan to assess the effectiveness, operational feasibility, and stakeholder preferences of a serial self-testing strategy for contact tracing within the Brazilian public health system. Our results will contribute to better understanding of the feasibility of a self-testing strategy within the public sector. Potential risks and limitations are discussed. Our findings will have important implications as governments continue working to mitigate the impact of COVID-19, particularly in the context of where to direct limited resources for testing and healthcare infrastructure. Registration: This trial is registered at ISCTRN (ISRCTN91602092).
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Affiliation(s)
| | - Camilo Manchola
- Global Health Strategies, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Raissa Stephanie
- Centro de Pesquisa em Medicina Tropical de Rondônia (CEPEM), Porto Velho, Rondônia, Brazil
| | - Tainá dos Santos Soares
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Fiocruz Paraná, Curitiba, Paraná, Brazil
| | | | - Milena Coelho
- Global Health Strategies, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Alexandre Dias Tavares Costa
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Fiocruz Paraná, Curitiba, Paraná, Brazil
| | - Dhélio Batista Pereira
- Centro de Pesquisa em Medicina Tropical de Rondônia (CEPEM), Porto Velho, Rondônia, Brazil
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6
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Herbert C, Shi Q, Baek J, Wang B, Kheterpal V, Nowak C, Suvarna T, Singh A, Hartin P, Durnam B, Schrader S, Harman E, Gerber B, Barton B, Zai A, Cohen-Wolkowiez M, Corbie-Smith G, Kibbe W, Marquez J, Hafer N, Broach J, Lin H, Heetderks W, McManus DD, Soni A. Association of neighborhood-level sociodemographic factors with Direct-to-Consumer (DTC) distribution of COVID-19 rapid antigen tests in 5 US communities. BMC Public Health 2023; 23:1848. [PMID: 37735647 PMCID: PMC10515232 DOI: 10.1186/s12889-023-16642-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Many interventions for widescale distribution of rapid antigen tests for COVID-19 have utilized online, direct-to-consumer (DTC) ordering systems; however, little is known about the sociodemographic characteristics of home-test users. We aimed to characterize the patterns of online orders for rapid antigen tests and determine geospatial and temporal associations with neighborhood characteristics and community incidence of COVID-19, respectively. METHODS This observational study analyzed online, DTC orders for rapid antigen test kits from beneficiaries of the Say Yes! Covid Test program from March to November 2021 in five communities: Louisville, Kentucky; Indianapolis, Indiana; Fulton County, Georgia; O'ahu, Hawaii; and Ann Arbor/Ypsilanti, Michigan. Using spatial autoregressive models, we assessed the geospatial associations of test kit distribution with Census block-level education, income, age, population density, and racial distribution and Census tract-level Social Vulnerability Index. Lag association analyses were used to measure the association between online rapid antigen kit orders and community-level COVID-19 incidence. RESULTS In total, 164,402 DTC test kits were ordered during the intervention. Distribution of tests at all sites were significantly geospatially clustered at the block-group level (Moran's I: p < 0.001); however, education, income, age, population density, race, and social vulnerability index were inconsistently associated with test orders across sites. In Michigan, Georgia, and Kentucky, there were strong associations between same-day COVID-19 incidence and test kit orders (Michigan: r = 0.89, Georgia: r = 0.85, Kentucky: r = 0.75). The incidence of COVID-19 during the current day and the previous 6-days increased current DTC orders by 9.0 (95% CI = 1.7, 16.3), 3.0 (95% CI = 1.3, 4.6), and 6.8 (95% CI = 3.4, 10.2) in Michigan, Georgia, and Kentucky, respectively. There was no same-day or 6-day lagged correlation between test kit orders and COVID-19 incidence in Indiana. CONCLUSIONS Our findings suggest that online ordering is not associated with geospatial clustering based on sociodemographic characteristics. Observed temporal preferences for DTC ordering can guide public health messaging around DTC testing programs.
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Affiliation(s)
- Carly Herbert
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
- Center for Clinical and Translational Science, University of Massachusetts, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Qiming Shi
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
- Center for Clinical and Translational Science, University of Massachusetts, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Biqi Wang
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
| | | | | | | | - Aditi Singh
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
| | - Paul Hartin
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
| | | | | | | | - Ben Gerber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Adrian Zai
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Giselle Corbie-Smith
- Department of Social Medicine, Department of Medicine, Center for Health Equity Research, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Warren Kibbe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Juan Marquez
- Washtenaw County Health Department, Washtenaw, MI, USA
| | - Nathaniel Hafer
- Center for Clinical and Translational Science, University of Massachusetts, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - John Broach
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Honghuang Lin
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
| | - William Heetderks
- National Institute of Biomedical Imaging and Bioengineering, NIH, Via Contract With Kelly Services, Bethesda, MD, USA
| | - David D McManus
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA
- Division of Cardiology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Apurv Soni
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, WorcesterWorcester, MA, 01655, USA.
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Division of Health System Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
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Singler L, Uhlenbrauck G, Corbie-Smith G, Richmond A, Hattem A, Linney K, Cohen-Wolkowiez M. Say Yes! COVID Test: A Health Communication Campaign to Encourage Use of Rapid, At-Home Antigen Testing in Underserved and Historically Marginalized Communities. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580221146046. [PMID: 36704996 PMCID: PMC9903010 DOI: 10.1177/00469580221146046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This paper describes a robust health communication campaign that supported Say Yes! COVID Test, the first National Institutes of Health (NIH)-sponsored initiative promoting community-wide, at-home, rapid antigen testing for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the cause of the COVID-19 pandemic. The primary goals of the health communication campaign were to promote awareness of the program among local residents, facilitate test kit distribution, and encourage frequent test kit use. To plan and implement the campaign, the team applied principles of social marketing. The populations of focus were adult residents of selected communities in North Carolina (Greenville, Pitt County) and Tennessee (Chattanooga, Hamilton County), with an emphasis on underserved and historically marginalized populations. Following an accelerated planning phase, the campaign included digital, out-of-home, television, and radio advertising, in addition to public relations and organic social media. Collectively, this campaign coupled with our grassroots community engagement efforts facilitated the distribution of 66 035 test kits across both communities, or more than 1.6 million at-home tests. Facebook ads were the most successful in driving online test kit orders (7.9% conversion rate in Pitt County; 8.1% conversion rate in Chattanooga), although employing a variety of marketing channels enabled reach across multiple subpopulations. Market research data indicated high program awareness but low uptake in testing. Lessons learned from campaign planning and implementation can inform future public health initiatives, including selecting the appropriate marketing mix to facilitate awareness, and collaborating with community partners and local health departments to ensure successful program execution.
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Affiliation(s)
- Lindsay Singler
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Gina Uhlenbrauck
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Al Richmond
- Community-Campus Partnerships for Health, Raleigh, NC, USA
| | - Amy Hattem
- Pitt County Health Department, Greenville, NC, USA
| | - Kristen Linney
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA,Michael Cohen-Wolkowiez, Duke Clinical Research Institute, 300 W Morgan St, Durham, NC 27701, USA.
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8
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Schliemann D, Ramanathan K, Ibrahim Tamin NSB, O'Neill C, Cardwell CR, Ismail R, Kassim Z, Kee F, Su TT, Donnelly M. Implementation of a home-based colorectal cancer screening intervention in Malaysia (CRC-SIM). BMC Cancer 2023; 23:22. [PMID: 36609260 PMCID: PMC9817284 DOI: 10.1186/s12885-022-10487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The Colorectal Cancer Screening Intervention for Malaysia (CRC-SIM) was a CRC study of home-based testing designed to improve low screening uptake using the immunochemical fecal occult blood test (iFOBT) in Malaysia. METHODS This quasi-experimental study was informed by the Implementation Research Logic Model and evaluated with the RE-AIM framework. Trained data collectors recruited by phone, randomly selected, asymptomatic adults aged 50-75 years from Segamat District, who previously completed a health census form for the South East Asia Community Observatory (SEACO). Participants were posted an iFOBT kit and asked to return a photo of the completed test for screening by health care professionals. A regression analysis of evaluation data was conducted to identify which variables were associated with the outcome indicators of 'study participation' and 'iFOBT completion' and the CRC-SIM was evaluated in terms of its appropriateness, feasibility and acceptability. RESULTS Seven hundred forty-seven eligible adults (52%) agreed to participate in this study and received an iFOBT kit. Participation was significantly lower amongst Chinese Malaysians (adjusted OR 0.45, 95% CI 0.35 - 0.59, p<0.001) compared to Malays and amongst participants from the rural sub-district (Gemereh) (adjusted OR 0.71, 95% CI 0.54 - 0.92, p=0.011) compared to the urban sub-district (Sungai Segamat). Less than half of participants (42%, n=311/747) completed the iFOBT. Test-kit completion was significantly higher amongst Chinese Malaysians (adjusted OR 3.15, 95% CI 2.11 - 4.69, p<0.001) and lower amongst participants with a monthly household income ≥RM 4,850 (adjusted OR 0.58, 95% CI 0.39 - 0.87, p=0.009) compared to participants with a lower household income. The main reported reason for non-participation was 'not interested' (58.6%) and main implementation challenges related to invalid photographs from participants and engaging iFOBT positive participants in further clinic consultations and procedures. CONCLUSION Home-testing for CRC (test completion) appeared to be acceptable to only around one-fifth of the target population in Malaysia. However, mindful of the challenging circumstances surrounding the pandemic, the CRC-SIM merits consideration by public health planners as a method of increasing screening in Malaysia, and other low- and middle-income countries.
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Affiliation(s)
- Désirée Schliemann
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK.
| | - Kogila Ramanathan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Petaling Jaya, Malaysia
| | | | - Ciaran O'Neill
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Christopher R Cardwell
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Roshidi Ismail
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Petaling Jaya, Malaysia
| | - Zaid Kassim
- Segamat District Health Office, Johor, Malaysia
| | - Frank Kee
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Tin Tin Su
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Petaling Jaya, Malaysia
| | - Michael Donnelly
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
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9
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Plunk AD, Hannon K, Carver A, Cooper D, Grant D, Greene S, Morgan E, Gehlert S. Developing a peer-led intervention to promote COVID-19 testing in low-income housing settings. Front Public Health 2023; 11:1096246. [PMID: 37213622 PMCID: PMC10196028 DOI: 10.3389/fpubh.2023.1096246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/05/2023] [Indexed: 05/23/2023] Open
Abstract
Background The Housing Collaborative project at Eastern Virginia Medical School has developed a method of adapting public health guidance from public housing communities, which face tremendous health challenges in cardiometabolic health, cancer, and other major health conditions. In this paper, we describe how academic and community partners in the Housing Collaborative came together to do this work with a focus on COVID-19 testing in the context of the emerging pandemic. Methods The academic team used virtual community engagement methods to interact with the Housing Collaborative Community Advisory Board (HCCAB) and a separate cohort of research participants (N = 102) recruited into a study of distrust in COVID-19 guidance. We conducted a series of 44 focus group interviews with participants on related topics. Results from these interviews were discussed with the HCCAB. We used the collaborative intervention planning framework to inform adaptation of public health guidance on COVID-19 testing delivered in low-income housing settings by including all relevant perspectives. Results Participants reported several important barriers to COVID-19 testing related to distrust in the tests and those administering them. Distrust in housing authorities and how they might misuse positive test results seemed to further undermine decision making about COVID-19 testing. Pain associated with testing was also a concern. To address these concerns, a peer-led testing intervention was proposed by the Housing Collaborative. A second round of focus group interviews was then conducted, in which participants reported their approval of the proposed intervention. Conclusion Although the COVID-19 pandemic was not our initial focus, we were able to identify a number of barriers to COVID-19 testing in low-income housing settings that can be addressed with adapted public health guidance. We struck a balance between community input and scientific rigor and obtained high quality, honest feedback to inform evidence-based recommendations to guide decisions about health.
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Affiliation(s)
- Andrew D. Plunk
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, United States
- *Correspondence: Andrew D. Plunk,
| | - Kapri Hannon
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Alexandra Carver
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Diane Cooper
- Housing Collaborative Community Advisory Board, Norfolk, VA, United States
| | - Debra Grant
- Housing Collaborative Community Advisory Board, Norfolk, VA, United States
| | - Sudie Greene
- Housing Collaborative Community Advisory Board, Norfolk, VA, United States
| | - Emma Morgan
- Housing Collaborative Community Advisory Board, Norfolk, VA, United States
| | - Sarah Gehlert
- Brown School of Social Work, Washington University, St. Louis, MO, United States
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10
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Ahmed A, Rossman W, Lu LC, Dunn CO, Harris AM, Priem JS, Hetherington TC, Porzucek AJ, Mores CN, Castri P, Lagarde WH, Dantuluri KL. Feasibility of At-Home Virological and Serological Testing for SARS-CoV-2 in Children. Open Forum Infect Dis 2022; 9:ofac459. [PMID: 36193228 PMCID: PMC9494384 DOI: 10.1093/ofid/ofac459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
Longitudinal virological and serological surveillance is essential for understanding SARS CoV-2 transmission among children but requires increased test capacity. We assessed the uptake of serial at-home testing in children (2-17 years) via mailed SARS-CoV-2 antibody and molecular tests. Completion rates demonstrated feasibility and sustainability of at-home testing across age groups.
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Affiliation(s)
- Amina Ahmed
- Department of Pediatrics (Infectious Diseases) at Levine Children’s Hospital , Atrium Health, Charlotte, NC , USA
| | - Whitney Rossman
- Center for Outcomes Research and Evaluation, Atrium Health , Charlotte, NC , USA
| | - Lauren C Lu
- Center for Outcomes Research and Evaluation, Atrium Health , Charlotte, NC , USA
| | - Connell O Dunn
- Department of Emergency Medicine Research, Atrium Health , Charlotte, NC , USA
| | - Anna M Harris
- Center for Outcomes Research and Evaluation, Atrium Health , Charlotte, NC , USA
| | - Jennifer S Priem
- Center for Outcomes Research and Evaluation, Atrium Health , Charlotte, NC , USA
| | | | - Abigail J Porzucek
- Milken Institute School of Public Health, The George Washington University , Washington, DC , USA
| | - Christopher N Mores
- Milken Institute School of Public Health, The George Washington University , Washington, DC , USA
| | - Paola Castri
- Atrium Health Wake Forest Baptist Health , Winston Salem, NC , USA
| | | | - Keerti L Dantuluri
- Department of Pediatrics (Infectious Diseases) at Levine Children’s Hospital , Atrium Health, Charlotte, NC , USA
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11
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Prazuck T, Gravier A, Pires‐Roteira D, Theillay A, Pallay S, Colin M, Serreau R, Hocqueloux L, Cassuto NG. Evaluation of a new "all in one" SARS-CoV-2 antigen-detecting rapid diagnostic test and self-test: Diagnostic performance and usability in child and adult populations. J Med Virol 2022; 94:4097-4106. [PMID: 35474460 PMCID: PMC9088384 DOI: 10.1002/jmv.27812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/15/2022] [Accepted: 04/22/2022] [Indexed: 11/09/2022]
Abstract
The control of the COVID-19 epidemics has been one global health priorities for the last 2 years. To that end, more reliable and easy-to-use, regardless of age, diagnostic tests are necessary. Considering that, we evaluated an innovative two-step self-test, the AAZ COVID-VIRO ALL IN®, switching from the classic nasal swab to a nasal sponge. We performed a multicenter study, on 124 adults and children, in a point-of-care setting. Sensitivity, specificity and overall acceptance of the COVID-VIRO ALL IN® self-test compared to reverse transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal samples were of 93.0%, 100%, and 97.5%, respectively. We then performed a multicenter, usability study to evaluate the ease of use of COVID-VIRO ALL IN® on 68 laypersons adults. A vast majority of participants correctly executed and interpreted the test. The usability was then specifically investigated on 40 children and teenagers, comparing COVID-VIRO® first generation to the new COVID-VIRO ALL IN®. They all found COVID-VIRO ALL IN® more comfortable and easier to use. For young children, the new self-test seems safer (less risk of trauma and no liquid exposure), and faster than saliva-based RT-PCR. Moreover, the COVID-VIRO ALL IN® can easily be adapted as a multiplex self-test for other respiratory viruses, opening new perspectives of simultaneous, rapid and massive detection of respiratory infections, especially among vulnerable populations like children and elderly people.
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Affiliation(s)
- Thierry Prazuck
- Centre gratuit d'information, de dépistage et de diagnostic (CeGIDD) Orléans, Centre Hospitalier Régional d'OrléansOrléansFrance
- Centre hospitalier régional d'Orléans, service des maladies infectieuses et tropicalesOrléansFrance
| | - Anne Gravier
- Centre gratuit d'information, de dépistage et de diagnostic (CeGIDD) Orléans, Centre Hospitalier Régional d'OrléansOrléansFrance
| | - Daniela Pires‐Roteira
- Centre hospitalier régional d'Orléans, service des maladies infectieuses et tropicalesOrléansFrance
| | - Aurelie Theillay
- Centre hospitalier régional d'Orléans, service des maladies infectieuses et tropicalesOrléansFrance
| | - Sandra Pallay
- Centre hospitalier régional d'Orléans, service des maladies infectieuses et tropicalesOrléansFrance
| | - Mathilda Colin
- Centre hospitalier régional d'Orléans, service des maladies infectieuses et tropicalesOrléansFrance
| | | | - Laurent Hocqueloux
- Centre hospitalier régional d'Orléans, service des maladies infectieuses et tropicalesOrléansFrance
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D'Agostino EM, Corbie G, Kibbe WA, Hornik CP, Richmond A, Dunston A, Damman A, Wruck L, Alvarado M, Cohen-Wolkowiez M. Increasing Access and Uptake of SARS-CoV-2 At-Home Tests Using a Community-Engaged Approach. Prev Med Rep 2022; 29:101967. [PMID: 36061814 PMCID: PMC9424120 DOI: 10.1016/j.pmedr.2022.101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/15/2022] [Accepted: 08/25/2022] [Indexed: 11/26/2022] Open
Abstract
Inequalities around COVID-19 testing and vaccination persist in the U.S. health system. We investigated whether a community-engaged approach could be used to distribute free, at-home, rapid SARS-CoV-2 tests to underserved populations. Between November 18-December 31, 2021, 400,000 tests were successfully distributed via 67 community partners and a mobile unit to a majority Hispanic/Latino/Spanish population in Merced County, California. Testing before gathering (59 %) was the most common testing reason. Asians versus Whites were more likely to test for COVID-19 if they had close contact with someone who may have been positive (odds ratio [OR] = 3.4, 95 % confidence interval [CI] = 1.7–6.7). Minors versus adults were more likely to test if they had close contact with someone who was confirmed positive (OR = 1.7, 95 % CI = 1.0–3.0), whereas Asian (OR = 4.1, 95 % CI = 1.2–13.7) and Hispanic/Latino/Spanish (OR = 2.5, 95 % CI = 1.0–6.6) versus White individuals were more likely to test if they had a positive household member. Asians versus Whites were more likely to receive a positive test result. Minors were less likely than adults to have been vaccinated (OR = 0.2, 95 % CI = 0.1–0.3). Among unvaccinated individuals, those who completed the survey in English versus Spanish indicated they were more likely to get vaccinated in the future (OR = 8.2, 95 % CI = 1.5–44.4). Asians versus Whites were less likely to prefer accessing oral COVID medications from a pharmacy/drug store only compared with a doctor’s office or community setting (OR = 0.3, 95 % CI = 0.2–0.6). Study findings reinforce the need for replicable and scalable community-engaged strategies for reducing COVID-19 disparities by increasing SARS-CoV-2 test and vaccine access and uptake.
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13
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Herbert C, Shi Q, Kheterpal V, Nowak C, Suvarna T, Durnan B, Schrader S, Behar S, Naeem S, Tarrant S, Kalibala B, Singh A, Gerber B, Barton B, Lin H, Cohen-Wolkowiez M, Corbie-Smith G, Kibbe W, Marquez J, Baek J, Hafer N, Gibson L, O’Connor L, Broach J, Heetderks W, McManus D, Soni A. Use of a Digital Assistant to Report COVID-19 Rapid Antigen Self-test Results to Health Departments in 6 US Communities. JAMA Netw Open 2022; 5:e2228885. [PMID: 36018589 PMCID: PMC9419013 DOI: 10.1001/jamanetworkopen.2022.28885] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/06/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Widespread distribution of rapid antigen tests is integral to the US strategy to address COVID-19; however, it is estimated that few rapid antigen test results are reported to local departments of health. Objective To characterize how often individuals in 6 communities throughout the United States used a digital assistant to log rapid antigen test results and report them to their local departments of health. Design, Setting, and Participants This prospective cohort study is based on anonymously collected data from the beneficiaries of the Say Yes! Covid Test program, which distributed more than 3 000 000 rapid antigen tests at no cost to residents of 6 communities (Louisville, Kentucky; Indianapolis, Indiana; Fulton County, Georgia; O'ahu, Hawaii; Ann Arbor and Ypsilanti, Michigan; and Chattanooga, Tennessee) between April and October 2021. A descriptive evaluation of beneficiary use of a digital assistant for logging and reporting their rapid antigen test results was performed. Interventions Widespread community distribution of rapid antigen tests. Main Outcomes and Measures Number and proportion of tests logged and reported to the local department of health through the digital assistant. Results A total of 313 000 test kits were distributed, including 178 785 test kits that were ordered using the digital assistant. Among all distributed kits, 14 398 households (4.6%) used the digital assistant, but beneficiaries reported three-quarters of their rapid antigen test results to their state public health departments (30 965 tests reported of 41 465 total test results [75.0%]). The reporting behavior varied by community and was significantly higher among communities that were incentivized for reporting test results vs those that were not incentivized or partially incentivized (90.5% [95% CI, 89.9%-91.2%] vs 70.5%; [95% CI, 70.0%-71.0%]). In all communities, positive tests were less frequently reported than negative tests (60.4% [95% CI, 58.1%-62.8%] vs 75.5% [95% CI, 75.1%-76.0%]). Conclusions and Relevance These results suggest that application-based reporting with incentives may be associated with increased reporting of rapid tests for COVID-19. However, increasing the adoption of the digital assistant may be a critical first step.
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Affiliation(s)
- Carly Herbert
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
| | - Qiming Shi
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
- Center for Clinical and Translational Science, University of Massachusetts Chan Medical School, Worcester
| | | | | | | | | | | | - Stephanie Behar
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
| | - Syed Naeem
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
| | - Seanan Tarrant
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
| | - Ben Kalibala
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
| | - Aditi Singh
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
| | - Ben Gerber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Honghuang Lin
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
| | | | - Giselle Corbie-Smith
- Center for Health Equity Research, Department of Social Medicine, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Warren Kibbe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Juan Marquez
- Washtenaw County Health Department, Washtenaw, Michigan
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Nathaniel Hafer
- Center for Clinical and Translational Science, University of Massachusetts Chan Medical School, Worcester
| | - Laura Gibson
- Division of Infectious Disease, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
| | - Laurel O’Connor
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester
| | - John Broach
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester
| | - William Heetderks
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, via contract with Kelly Services, Bethesda, Maryland
| | - David McManus
- Division of Cardiology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
| | - Apurv Soni
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
- Division of Clinical Informatics, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
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14
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Nwaozuru U, Obiezu-Umeh C, Diallo H, Graham D, Whembolua GL, Bourgeau MJ, Ritchwood TD, Nelson LE, Shato T, Mathews A, Moise R, Ward MC, Raude J, Ahonkhai AA, Young DJ, Conserve DF. Perceptions of COVID-19 self-testing and recommendations for implementation and scale-up among Black/African Americans: implications for the COVID-19 STEP project. BMC Public Health 2022; 22:1220. [PMID: 35725400 PMCID: PMC9207861 DOI: 10.1186/s12889-022-13619-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND COVID-19 self-testing (ST) is an innovative strategy with the potential to increase the access and uptake of testing and ultimately to limit the spread of the virus. To maximize the uptake and reach of this promising strategy and inform intervention development and scale up, research is needed to understand the acceptability of and willingness to use this tool. This is vital to ensure that Black/African Americans are reached by the Biden-Harris Administration's free national COVID-19 ST program. This study aimed to explore the acceptability and recommendations to promote and scale-up the uptake of COVID-19 ST among Black/African Americans. METHODS We conducted a cross-sectional qualitative study using a semi-structured questionnaire to assess barriers and facilitators to the uptake of COVID-19 ST among a convenience sample of 28 self-identified Black/African Americans from schools, community centers, and faith-based institutions in Ohio and Maryland. Inductive content analysis was conducted to identify categories and subcategories related to acceptability and recommendations for implementing and scaling up COVID-19 ST in communities. RESULTS Participants perceived COVID-19 self-testing as an acceptable tool that is beneficial to prevent transmission and address some of the barriers associated with health facility testing, such as transportation cost and human contact at the health facility. However, concerns were raised regarding the accurate use of the kits and costs. Recommendations for implementing and scaling up COVID-19 ST included engagement of community stakeholders to disseminate information about COVID-19 self-testing and creating culturally appropriate education tools to promote knowledge of and clear instructions about how to properly use COVID-19 ST kits. Based on these recommendations, the COVID-19 STEP (Self-Testing Education and Promotion) Project is being developed and will involve engaging community partners such as barbers, church leaders, and other community-based organizations to increase the uptake and use of free COVID-19 ST kits among Black/African Americans. CONCLUSION Findings showed that most participants considered COVID-19 ST valuable for encouraging COVID-19 testing. However, cost and accuracy concerns may pose barriers. Future work should consider implementing interventions that leverage the benefits of COVID-19 ST and further assess the extent to which these identified facilitators and barriers may influence COVID-19 ST uptake.
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Affiliation(s)
- Ucheoma Nwaozuru
- grid.241167.70000 0001 2185 3318Department of Implementation Science, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC 27101 USA
| | - Chisom Obiezu-Umeh
- grid.262962.b0000 0004 1936 9342College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Saint Louis, MO 63104 USA
| | - Hassim Diallo
- grid.164295.d0000 0001 0941 7177School of Public Health, University of Maryland, College Park, MD 20742 USA
| | - Danielle Graham
- grid.24827.3b0000 0001 2179 9593Department of Africana Studies, University of Cincinnati, 2815 Commons Way, Cincinnati, OH 45221-0370 USA
| | - Guy-Lucien Whembolua
- grid.24827.3b0000 0001 2179 9593Department of Africana Studies, University of Cincinnati, 2815 Commons Way, Cincinnati, OH 45221-0370 USA
| | - Marie Janeeca Bourgeau
- grid.262273.00000 0001 2188 3760Department of Psychology, Queens College, City University of New York, 65-30 Kissena Blvd, Queens, New York, NY 11567 USA
| | - Tiarney D. Ritchwood
- grid.26009.3d0000 0004 1936 7961Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W Main St, Durham, NC 27705 USA
| | - LaRon E. Nelson
- grid.47100.320000000419368710School of Nursing, Yale University, 400 West Campus Drive, Orange, CT 06477 USA
| | - Thembekile Shato
- grid.4367.60000 0001 2355 7002Washington University in Saint Louis, Brown School, 1 Brookings Drive, Saint Louis, MO 63130 USA
| | - Allison Mathews
- grid.241167.70000 0001 2185 3318Gilead COMPASS Faith Coordinating Center, School of Divinity, Wake Forest University, 2596 Reynolda Rd., Suite 215C, Winston-Salem, NC 27106 USA
| | - Rhoda Moise
- Rhoda Moise, LLC, 127 Church Road, Elkins Park, PA 19027 USA
| | - Maranda C. Ward
- grid.253615.60000 0004 1936 9510School of Medicine and Health Science, The George Washington University, 2600 Virginia Ave, NW, Washington, DC, 20036 USA
| | - Jocelyn Raude
- grid.414412.60000 0001 1943 5037EHESP School of Public Health, Avenue du Pr Leon Bernard, F-35000 Rennes, France
| | - Aima A. Ahonkhai
- grid.412807.80000 0004 1936 9916Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, USA
| | - Diane J. Young
- grid.430001.60000 0004 0623 0683Prince George’s County Health Department, Family Health Services, Largo, MD 20774 USA
| | - Donaldson F. Conserve
- grid.253615.60000 0004 1936 9510The George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052 USA
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Herbert C, Shi Q, Kheterpal V, Nowak C, Suvarna T, Durnam B, Schrader S, Behar S, Naeem S, Tarrant S, Kalibala B, Singh A, Gerber B, Barton B, Lin H, Cohen-Wolkowiez M, Corbie-Smith G, Kibbe W, Marquez J, Baek J, Hafer N, Gibson L, O'Connor L, Broach J, Heetderks W, McManus D, Soni A. If you build it, will they use it? Use of a Digital Assistant for Self-Reporting of COVID-19 Rapid Antigen Test Results during Large Nationwide Community Testing Initiative. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.03.31.22273242. [PMID: 35411338 PMCID: PMC8996627 DOI: 10.1101/2022.03.31.22273242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Wide-spread distribution of rapid-antigen tests is integral to the United States' strategy to address COVID-19; however, it is estimated that few rapid-antigen test results are reported to local departments of health. Objective To characterize how often individuals in six communities throughout the United States used a digital assistant to log rapid-antigen test results and report them to their local Department of Health. Design This prospective cohort study is based on anonymously collected data from the beneficiaries of The Say Yes! Covid Test program, which distributed 3,000,000 rapid antigen tests at no cost to residents of six communities between April and October 2021. We provide a descriptive evaluation of beneficiaries' use of digital assistant for logging and reporting their rapid antigen test results. Main Outcome and Measures Number and proportion of tests logged and reported to the Department of Health through the digital assistant. Results A total of 178,785 test kits were ordered by the digital assistant, and 14,398 households used the digital assistant to log 41,465 test results. Overall, a small proportion of beneficiaries used the digital assistant (8%), but over 75% of those who used it reported their rapid antigen test results to their state public health department. The reporting behavior varied between communities and was significantly different for communities that were incentivized for reporting test results (p < 0.001). In all communities, positive tests were less reported than negative tests (60.4% vs 75.5%; p<0.001). Conclusions and Relevance These results indicate that app-based reporting with incentives may be an effective way to increase reporting of rapid tests for COVID-19; however, increasing the adoption of the digital assistant is a critical first step.
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Perkins SE, Shilling F, Collinson W. Anthropause Opportunities: Experimental Perturbation of Road Traffic and the Potential Effects on Wildlife. Front Ecol Evol 2022. [DOI: 10.3389/fevo.2022.833129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The SARS-CoV-2 pandemic severely reduced many human activities. So pronounced was the change, it has given rise to the term “anthropause”: the considerable alteration of modern human activities. Among these was surface transportation, with prolonged traffic reductions, in excess, of 50% in many countries. Roads and traffic are responsible for functionally fragmenting ecosystems, wildlife populations, and species interactions. The unintentional “dialing-down” of traffic has given continuous monitoring systems of wildlife-vehicle conflict a unique opportunity to study the consequences of perturbing this source of wildlife disturbance and mortality. Experimental manipulation of traffic at the global scale would not have been possible without mitigation responses to SARS-CoV-2. Such a perturbation allows robust empirical investigation into wildlife responses to traffic, including changes in mortality, behavior, genetic connectivity, and knock-on ecosystem effects, the responses to which can be replicated across a global network of wildlife-vehicle conflict monitoring systems. We review the extent to which these extensive data-collection systems provide the primary source of data to study many of these responses, providing the raw material to understand some striking wildlife consequences of the anthropause.
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17
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Nwaozuru U, Obiezu-Umeh C, Diallo H, Graham D, Whembolua GL, Bourgeau MJ, Ritchwood T, Nelson LE, Shato T, Mathews A, Moise R, Ward MC, Raude J, Ahonkhai AA, Young DJ, Conserve DF. Perceptions of COVID-19 Self-Testing and Recommendations for Implementation and Scale up Among Black/African Americans: Implications for the COVID-19 STEP Project. RESEARCH SQUARE 2022:rs.3.rs-1277219. [PMID: 35194597 PMCID: PMC8863154 DOI: 10.21203/rs.3.rs-1277219/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background COVID-19 self-testing (ST) is an innovative strategy with the potential to increase the access and uptake of testing and ultimately to limit the spread of the virus. To maximize the uptake and reach of this promising strategy and inform intervention development and scale up, research is needed to understand the acceptability of and willingness to use this tool. This is vital to ensure that Black/African Americans are reached by the Biden-Harris Administration’s free national COVID-19 ST program. This study aimed to explore the acceptability and recommendations to promote and scale up the uptake of COVID-19 ST among Black/African Americans. Methods We conducted a cross-sectional qualitative study using a semi-structured survey to assess barriers and facilitators to the uptake of COVID-19 ST among a convenience sample of 28 self-identified Black/African Americans from schools, community centers, and faith-based institutions in Ohio and Maryland. Inductive content analysis was conducted to identify categories and subcategories related to acceptability and recommendations for implementing and scaling up COVID-19 ST in communities. Results Participants perceived COVID-19 self-testing as an acceptable tool that is beneficial to prevent transmission and address some of the barriers associated with health facility testing, such as transportation cost and human contact at the health facility. However, concerns were raised regarding the accurate use of the kits and costs. Recommendations for implementing and scaling up COVID-19 ST included engagement of community stakeholders to disseminate information about COVID-19 self-testing and creating culturally appropriate education tools to promote knowledge of and clear instructions about how to properly use COVID-19 ST kits. Based on these recommendations, the COVID-19 STEP (Self-Testing Education and Promotion) Project is being developed and will involve engaging community partners such as barbers, church leaders, and other community-based organizations to increase the uptake and use of free COVID-19 ST kits among Black/African Americans. Conclusion Findings showed that most participants considered COVID-19 ST valuable for encouraging COVID-19 testing. However, cost and accuracy concerns may pose barriers. Future work should consider implementing interventions that leverage the benefits of COVID-19 ST and further assess the extent to which these identified facilitators and barriers may influence COVID-19 ST uptake.
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18
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Ciccone EJ, Conserve DF, Dave G, Hornik CP, Kuhn ML, Herling JL, Song M, Alston S, Singler L, Schmidt MD, Jones A, Broderick S, Wruck LM, Kibbe WA, Aiello AE, Woods CW, Richmond A, Cohen-Wolkowiez M, Corbie-Smith G. Correction to: At-home testing to mitigate community transmission of SARS-CoV-2: protocol for a public health intervention with a nested prospective cohort study. BMC Public Health 2022; 22:151. [PMID: 35062914 PMCID: PMC8781689 DOI: 10.1186/s12889-021-12442-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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