Abstract
BackgroundAscertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission.ObjectiveThis study aims to determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission.MethodsWe used a discrete choice experiment to assess preferences for SARS-CoV-2 test type, specimen type, testing venue, and results turnaround time. Participants (n=4793) from the US national longitudinal Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study completed our online survey from July 30 to September 8, 2020. We estimated the relative importance of testing method attributes and part-worth utilities of attribute levels, and simulated the uptake of an optimized testing scenario relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal swab in a provider’s office or urgent care clinic with results in >5 days.ResultsTest result turnaround time had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). In simulations, immediate or same-day test results, both PCR and serology, or oral specimens substantially increased testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same-day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test.ConclusionsTesting strategies that offer both PCR and serology with noninvasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2.
Highlights
The Centers for Disease Control and Prevention recently estimated that for every case of SARS-CoV-2 infection diagnosed in the United States, an additional 10 are undiagnosed [1]
A test scenario that included a specimen collected at home and returned to the lab via mail could not include the immediate test result level. bDescriptive text was displayed in the choice exercise. cPCR: polymerase chain reaction. dNP: nasopharyngeal
We simulated the proportion of participants that would pick the current typical testing scenario versus a scenario with multiple more preferable features: both PCR and serology using a saliva specimen collected at a pharmacy with same-day test results
Summary
The Centers for Disease Control and Prevention recently estimated that for every case of SARS-CoV-2 infection diagnosed in the United States, an additional 10 are undiagnosed [1]. Detecting a higher proportion of people with active infection via widespread testing is a prerequisite to achieving the public health goals of controlling the transmission of SARS-CoV-2 [2,3]. Understanding factors that may influence an individual’s decision to seek testing can help enhance and sustain uptake of SARS-CoV-2 testing when, where, and among whom it is needed most for public health purposes. These factors include individual preferences for different types of testing services, which have not been systematically ascertained or incorporated into testing service delivery. Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission
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