Community-based SARS-CoV-2 testing in low-income neighbourhoods in Rotterdam: Results from a pilot study

Abstract

Background: High incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and low testing uptake were reported in low-income neighbourhoods in Rotterdam. We aimed to improve willingness and access to testing by introducing community-based test facilities, and to evaluate the effectiveness of a rapid antigen detection test (RDT).

Methods: Two to eleven test facilities operated consecutively in three low-income neighbourhoods in Rotterdam, offering the options of walk-in or appointments. Background characteristics were collected at intake and one nasopharyngeal swab was taken and processed using both RDT and reverse transcription polymerase chain reaction (RT-PCR). Visitors were asked to join a survey for evaluation purposes.

Results: In total, 19 773 visitors were tested - 9662 (48.9%) without an appointment. Walk-in visitors were older, lived more often in the proximity of the test facilities, and reported coronavirus disease (COVID-19)-related symptoms less often than by-appointment visitors. For 67.7% of the visitors, this was the first time they got tested. A total of 1211 (6.1%) tested SARS-CoV-2-positive with RT-PCR, of whom 309 (25.5%) were asymptomatic. Test uptake increased among residents of the pilot neighbourhoods, especially in the older age groups, compared to people living in comparable neighbourhoods without community-based testing facilities. RDT detected asymptomatic individuals with 71.8% sensitivity, which was acceptable in this high prevalence setting. Visitors reported positive attitudes towards the test facilities and welcomed the easy access.

Conclusions: Offering community-based SARS-CoV-2 testing seems a promising approach for increasing testing uptake among specific populations in low-income neighbourhoods.

Figure 1

Map of Rotterdam, with the pilot locations 1, 2 and 3 and the comparator locations A and B highlighted (derived from Google maps).

Figure 2

Cumulative number of residents of location 3 (Charlois) and comparator location B (IJsselmonde) having undergone a SARS-CoV-2 test, per 10,000 population. The area between the vertical lines indicates the 6-week intervention period in location 3 (Charlois). For reasons of simplicity, this figure only shows the number of SARS-CoV-2 tests from November 1, 2020 onwards. The red line indicates location 3 (Charlois), while the blue line indicates the comparator location B (IJsselmonde).