Evaluation of feasibility and user acceptance of lateral-flow self-testing for viral illness in a residential treatment rehabilitation facility

Abstract

Background: The role of rapid testing has proven vital in reducing infection incidence in communities through swift identification and isolation of infected individuals. The COVID-19 pandemic has been particularly catastrophic for residential carceral and rehabilitation facilities that are high-risk settings for transmission of contagious diseases. Centralized provider-based viral testing employing conventional diagnostic techniques is labor-intensive and time-consuming. There is a marked unmet need for quick, inexpensive, and simple viral testing strategies. We hypothesized that rehabilitation residents could successfully test themselves employing inexpensive, disposable, antigen-based influenza lateral-flow tests and would be willing to self-isolate and self-report to health authorities if positive.

Methods: We evaluated self-testing among 50 rehabilitation residents ages 18 and older in Pomona, California, where participants self-administered influenza lateral-flow diagnostic test (without specimen collection) with the goal of appropriately observing a control line and completed two brief written surveys on self-testing and COVID-19, one before self-administering the lateral-flow test and one after, to determine the overall feasibility of viral self-testing and to characterize attitudes comparing self-testing and provider-based testing.

Findings: A total of 50 rehabilitation residents were enrolled in this study and all 50 conducted a lateral-flow test and answered the provided surveys. Among the participants, 96% (48 of 50) achieved a positive-control line from their lateral-flow test. Most participants, 83% (34 of 41) indicated that they would prefer to perform their own rapid test instead of having a health care provider administer the test. Notably, 98% (49 of 50) indicated that they would self-isolate if the lateral-flow test returned a positive indicator suggesting the presence of a viral infection and 96% (48 of 50) would report positive results to their corresponding public health department.

Interpretation: Residents in a residential rehabilitation center were widely able to successfully self-administer standard lateral-flow antigen-based rapid diagnostic kits. Self-testing was strongly preferred over tests administered by a healthcare provider. Reassuringly, almost every resident indicated that they would report any positive test result to the health department and self-isolate accordingly. Self-testing offers a promising adjunct to centralized testing, potentially better enabling swift and effective management of life-threatening infectious outbreaks among those living in high-risk congregate living settings.

Keywords: COVID-19; Influenza; Lateral-flow test; Rapid test; SARS-CoV-2; Self-testing; Viral screening.

Fig. 1

Demographics and additional characteristics of the 2020–2021 Prototypes rehabilitation population. A Age distribution, B Racial demographics, C Total number of clients with children, and D Distribution of the average length of stay

Fig. 2

Overall distribution of answers to each of the questions asked on the pre-test and post-test surveys. The pre-test survey was taken before the self-administration of the lateral-flow test, likewise, the post-test survey was taken after completion of the lateral-flow test

Fig. 3

Heatmap of all individual participant responses employing a 7-point scale (1: strongly disagree to 7: strongly agree) that characterize opinions about self-testing in response to the following statements. A “I felt comfortable administering my own test,” (B) “the test was not difficult to perform,” and (C) “I could teach others to perform these tests.” The mean responses to questions A, B and C were 6.36 +/− 1.69, 5.61 +/− 2.35, and 6.56 +/− 1.43 respectively. Nine of 50 participants did not submit responses. The 7-point heatmap scale is provided to the right of the figure