The Aaron Diamond AIDS Research Center, Columbia University, New York, New York, United States of America.
Department of Biomedical Engineering, Columbia University, New York, New York, United States of America.
PLoS One. 2022 Aug 8;17(8):e0267766. doi: 10.1371/journal.pone.0267766. eCollection 2022.
Widespread use of at-home rapid COVID-19 antigen tests has been proposed as an important public health intervention to interrupt chains of transmission. Antigen tests may be preferred over PCR because they provide on-demand results for relatively low cost and can identify people when they are most likely to be infectious, particularly when used daily. Yet the extent to which a frequent antigen testing intervention will result in a positive public health impact for COVID-19 will depend on high acceptability and high adherence to such regimens.
We conducted a mixed-methods study assessing acceptability of and adherence to a daily at-home mobile-app connected rapid antigen testing regimen among employees of a US-based media company. Acceptability was assessed across seven domains of the Theoretical Framework of Acceptability.
Among 31 study participants, acceptability of the daily testing intervention was generally high, with participants reporting high perceived effectiveness, intervention coherence, and self-efficacy; positive affective attitude; acceptable degree of burden and opportunity cost; and assessing the intervention as ethical. 71% reported a preference to test daily using an at-home antigen test than weekly employment-based PCR. Mean adherence to the 21-day testing regimen was 88% with 43% of participants achieving 100% adherence, 48% testing at least every other day, and 10% testing less than every other day.
Despite overall high acceptability and adherence, we identified three implementation challenges that must be addressed for frequent serial testing for COVID-19 to be implemented at scale and have a positive public health impact. First, users need guidance on how and when to adapt testing frequencies to different epidemiological conditions. Second, users and institutions need guidelines for how to safely store and share test results. Third, implementation of serial testing strategies must prioritize health equity and protect those most vulnerable to COVID-19.
家庭使用的快速 COVID-19 抗原检测被广泛提议作为一项重要的公共卫生干预措施，以阻断传播链。抗原检测可能比 PCR 更受欢迎，因为它们可以提供按需结果，成本相对较低，并且可以在人们最有可能具有传染性时识别出他们，尤其是当每天使用时。然而，频繁的抗原检测干预将在多大程度上对 COVID-19 产生积极的公共卫生影响，将取决于对这些方案的高度接受度和高度依从性。
我们进行了一项混合方法研究，评估了一家美国媒体公司员工对每日家庭移动应用连接的快速抗原检测方案的可接受性和依从性。可接受性通过可接受性理论框架的七个领域进行评估。
在 31 名研究参与者中，每日检测干预的可接受性通常较高，参与者报告了高感知有效性、干预一致性和自我效能感；积极的情感态度；可接受的负担和机会成本程度；并认为干预符合伦理。71%的人表示更愿意使用家庭抗原检测进行每日检测，而不是每周进行基于就业的 PCR。21 天检测方案的平均依从率为 88%，其中 43%的参与者达到了 100%的依从率，48%至少每两天检测一次，10%每两天检测一次。
尽管总体上可接受性和依从性较高，但我们确定了三个实施挑战，必须解决这些挑战，才能大规模实施频繁的连续 COVID-19 检测并产生积极的公共卫生影响。首先，用户需要指导如何以及何时根据不同的流行病学条件调整检测频率。其次，用户和机构需要指导方针，以安全地存储和共享检测结果。第三，连续检测策略的实施必须优先考虑健康公平性，并保护那些最易感染 COVID-19 的人。
