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Pollock NR, Tran K, Jacobs JR, Cranston AE, Smith S, O’Kane CY, Roady TJ, Moran A, Scarry A, Carroll M, Volinsky L, Perez G, Patel P, Gabriel S, Lennon NJ, Madoff LC, Brown C, Smole SC. Performance and Operational Evaluation of the Access Bio CareStart Rapid Antigen Test in a High-Throughput Drive-Through Community Testing Site in Massachusetts. Open Forum Infect Dis 2021; 8:ofab243. [PMID: 34250188 PMCID: PMC8244626 DOI: 10.1093/ofid/ofab243] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To facilitate deployment of point-of-care testing for severe acute respiratory syndrome coronavirus 2, we evaluated the Access Bio CareStart COVID-19 Antigen test in a high-throughput, drive-through, free community testing site using anterior nasal (AN) swab reverse-transcription polymerase chain reaction (RT-PCR) for clinical testing. METHODS Consenting symptomatic and asymptomatic children (≤18 years) and adults received dual AN swabs. CareStart testing was performed with temperature/humidity monitoring. All tests had 2 independent reads to assess interoperator agreement. Patients with positive CareStart results were called and instructed to isolate pending RT-PCR results. The paired RT-PCR result was the reference for sensitivity and specificity calculations. RESULTS Of 1603 participants, 1245 adults and 253 children had paired RT-PCR/CareStart results and complete symptom data. Eighty-three percent of adults and 87% of children were asymptomatic. CareStart sensitivity/specificity were 84.8% (95% confidence interval [CI], 71.1-93.7)/97.2% (95% CI, 92.0-99.4) and 85.7% (95% CI, 42.1-99.6)/89.5% (95% CI, 66.9-98.7) in adults and children, respectively, within 5 days of symptoms. Sensitivity/specificity were 50.0% (95% CI, 41.0-59.0)/99.1% (95% CI, 98.3-99.6) in asymptomatic adults and 51.4% (95% CI, 34.4-68.1)/97.8% (95% CI, 94.5-99.4) in asymptomatic children. Sensitivity in all 234 RT-PCR-positive people was 96.3% with cycle threshold (Ct) ≤25, 79.6% with Ct ≤30, and 61.4% with Ct ≤35. All 21 false-positive CareStart tests had faint but normal bands. Interoperator agreement was 99.5%. Operational challenges included identification of faint test bands and inconsistent swab elution volumes. CONCLUSIONS CareStart had high sensitivity in people with Ct ≤25 and moderate sensitivity in symptomatic people overall. Specificity was unexpectedly lower in symptomatic versus asymptomatic people. Excellent interoperator agreement was observed, but operational challenges indicate that operator training is warranted.
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Affiliation(s)
- Nira R Pollock
- Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Kristine Tran
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Jesica R Jacobs
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
- Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amber E Cranston
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Sita Smith
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Claire Y O’Kane
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Tyler J Roady
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Anne Moran
- Lawrence General Hospital, Lawrence, Massachusetts, USA
| | - Alison Scarry
- Lawrence General Hospital, Lawrence, Massachusetts, USA
| | | | | | - Gloria Perez
- Lawrence General Hospital, Lawrence, Massachusetts, USA
| | - Pinal Patel
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Stacey Gabriel
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Niall J Lennon
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Lawrence C Madoff
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
- Division of Infectious Disease and Immunology, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Catherine Brown
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Sandra C Smole
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
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