Home Test Kits Research Articles

Post-Vasectomy Semen Analysis: What's All the Fuss about?

Vasectomy is a reliable male contraceptive method with a success rate exceeding 98%. Despite its efficacy, vasectomy is not foolproof, with potential early and late failures requiring careful postoperative monitoring via post-vasectomy semen analysis (PVSA). Published guidelines emphasize the necessity of conducting PVSA to ensure clinical sterility. Despite these clear guidelines, discrepancies in adherence and interpretation persist, with significant mismatches between guidelines and actual practice. Recent shifts in societal attitudes toward reproductive autonomy, spurred by significant political events and socioeconomic factors, have increased vasectomy rates, particularly among younger, childless men. This demographic change calls for enhanced PVSA compliance and clear communication about the non-immediate contraceptive effect of vasectomy. Home test kits have emerged as a convenient, though not always reliable, method for conducting PVSAs, which may require reevaluation in clinical practice. Given the variations across clinical guidelines and the challenges in achieving consistent PVSA outcomes, further research is needed to harmonize PVSA protocols across different health systems. PVSA is typically conducted between 8 and 16 weeks post-vasectomy, depending on the surgeon's preference. Success is confirmed when a fresh, uncentrifuged sample exhibits either azoospermia, rare non-motile sperm (RNMS), or fewer than 100,000 non-motile sperm per milliliter. This effort will ensure that both patients and practitioners can rely on vasectomy as a safe and effective form of contraception. Effective patient counseling and strategic follow-up are crucial when it comes to managing expectations and ensuring compliance with post-vasectomy protocols, thereby minimizing the risk of unintended pregnancies post-procedure.

Summary of Varieties and Diversities of Nanomaterials Used in Food Safety and Quality

In all fields of life sciences, the trends toward sustainability, enhanced product safety, and high standards of quality are significant. The food industry uses intelligent packaging to meet these needs. These systems can continuously monitor a product's quality status and notify the customer of any changes. Conventional methods can only satisfy the needs of regular laboratory food analysis. Thus, in the cases of major food safety concerns, quick, economical, and time-saving analysis techniques, including portable, on-site, and home testing kits, are desperately needed. Nonetheless, there is a chance that nanoparticles could be harmful to people's health. Nanotechnology, for instance, can be applied to food processing to improve food's overall quality, including taste, flavor, and bioavailability. It can also help products last longer on the shelf. Moreover, nanotechnology is often applied to food packaging to deliver innovative packaging and serve as an antimicrobial agent. It can offer fresh approaches to thwart fraud and serve as a valuable weapon in our toolbox to prevent bioterrorism. As a result, it is advised to set up a sufficient regulatory framework to control any dangers related to applications of nanotechnology. This review addresses the classification and safety issues involved in the application of nanotechnology in food safety and packaging.

“The 70s Are the New 50s. Nothing Is, However, for Free” – The Affective Biopolitics of Andropause and Testosterone on Danish Websites

ABSTRACT Andropause, the notion that men’s aging is affected by a declining testosterone production, has until recently been a somewhat unknown phenomenon in the Danish context. However, as a growing number of Danish websites are disseminating information about ‘the male climacteric’, a new hormone centered health discourse about the male body is emerging. In this article, we analyze a corpus of 50 Danish websites consisting of both online media articles and websites marketing products for ‘andropausal’ men. We show how men’s health and performances of masculinity in mid- and later life is entangled in biomedical discourses of risk and self-surveillance, as well as (biopolitical) affects centering aging men’s sexual capacities. We base our analysis in new materialist thinking which outlines affect, biopolitics and complexity as entry points to embodied dimensions of masculinity. We argue that the growing attention to andropause promote new norms for aging in which the aging body is designated as unhealthy and the individual is required to remain vital and capable throughout life. Finally, drawing on Steve Garlick, we show how online available testosterone home-testing kits can be read as illustrative of the theory of masculinity as a technology of embodiment which rests upon the control over nature.

Analyzing the Costs and Impact of the TakeMeHome Program, a Public-Private Partnership to Deliver HIV Self-Test Kits in the United States.

HIV testing is an entry point to access HIV care and prevention services. Building Healthy Online Communities developed a website ( TakeMeHome.org ) where participants can order HIV home test kits. The purpose of this study was to analyze the costs and impact of the TakeMeHome program. We estimated the costs of TakeMeHome across all participating jurisdictions for the first year of the program. We estimated program costs using purchase orders and invoices, contracts, and allocation of staff time, and the costs included website design, participant recruitment, administration and overhead, HIV self-test kits, and shipping and handling. Primary outcomes of the analysis were total program cost, cost per HIV test, and cost per new HIV diagnosis. The TakeMeHome program distributed 5323 HIV self-tests to 4859 participants over a 12-month period. The total program cost over this period was $314,870. The cost per HIV test delivered was estimated at $59, and the cost per person tested was $65. The program identified 18 confirmed new HIV diagnoses (0.6% positivity) verified with surveillance data in 7 health jurisdictions at $169,890. The cost per confirmed new HIV diagnosis was estimated at $9440. The TakeMeHome program delivered HIV self-testing at a reasonable cost, and the program may be a cost-effective use of HIV prevention resources. The public-private partnership can be an effective mechanism to validate HIV diagnoses identified with self-testing and provide HIV prevention and linkage to care services.

Young, Black/African American, and Latino communities are left behind despite legislative efforts in California to reduce HIV/STI disparities.

Sexually transmitted infections (STI) have been on the rise in the United States with racial/ethnic minority groups, gay and bisexual men, and youth experiencing the highest STI and HIV infection rates. In 2022, California became the first state in the nation to pass legislation, Senate Bill 306 (SB 306), requiring health care plans to cover the costs of home test kits for STIs, including HIV. This study examines provisions within SB 306 and its potential to reduce STI and HIV disparities among key demographic groups and geographic regions within California. Ecological cross-sectional study involving 58 California counties. Descriptive statistics and choropleth maps compared HIV/STI prevalence rates, uninsured rates, demographic composition, and healthcare provider coverage across California counties. Three geographically weighted Poisson regression analyses were conducted to separately examine the association between proportion of uninsured and HIV, gonorrhea, and chlamydia prevalence rates. HIV/STI rates were significantly and positively associated with the proportion of uninsured residents in Central and Southern California counties. These counties had a higher proportion of demographic groups vulnerable to HIV/STI including a large Latino, Black/African American, and younger (age 15-24) population but had a lower rate of healthcare providers with prescription authority for home testing kits, which is a requirement under SB 306. Cutting-edge solutions are needed to stem the rising tide of new STI and HIV infections. While SB 306 is novel and innovative in intent, its coverage gaps will increase disparities and inequities among historically underserved populations.

HIV prevention and the impact of It’s a Sin in Scotland

HIV prevention services across the United Kingdom received unprecedented requests for home testing kits following the airing of Russell T. Davies’s television series It’s a Sin (IAS) in January and February 2021. Professionals suggested a link between IAS’s retelling of AIDS crisis histories and people’s fears of ongoing HIV transmission, thus leading to increased online searches about HIV/AIDS. Little has been written about this impact of IAS on HIV health promotion practices specifically. Thus, in this article, I analyse a series of interviews with HIV health promoters in Scotland to detail how IAS has influenced HIV intervention techniques and health promotion strategies. I demonstrate how IAS provoked local and national dialogues about the contemporary context of HIV/AIDS in Scotland. I argue that it enabled conversations about the need for new media resources that accurately represent the specific and localized histories of HIV/AIDS. More directly, IAS in small part illuminated differences in intervention strategies between England and Scotland. Hence, it foregrounded the need for re-distributed institutional and material resources to streamline a Scottish agenda for ‘ending HIV’ by 2030.

Use of COVIDTests.gov At-Home Test Kits Among Adults in a National Household Probability Sample — United States, 2022

At-home rapid antigen COVID-19 tests were first authorized by the Food and Drug Administration in late 2020 (1-3). In January 2022, the White House launched COVIDTests.gov, which made all U.S. households eligible to receive free-to-the-user at-home test kits distributed by the U.S. Postal Service (2). By May 2022, more than 70 million test kit packages had been shipped to households across the United States (2); however, how these kits were used, and which groups were using them, has not been reported. Data from a national probability survey of U.S. households (COVIDVu), collected during April-May 2022, were used to evaluate awareness about and use of these test kits (4). Most respondent households (93.8%) were aware of the program, and more than one half (59.9%) had ordered kits. Among persons who received testing for COVID-19 during the preceding 6 months, 38.3% used a COVIDTests.gov kit. Among kit users, 95.5% rated the experience as acceptable, and 23.6% reported being unlikely to have tested without the COVIDTests.gov program. Use of COVIDTests.gov kits was similar among racial and ethnic groups (42.1% non-Hispanic Black or African American [Black]; 41.5% Hispanic or Latino [Hispanic]; 34.8% non-Hispanic White [White]; and 53.7% non-Hispanic other races [other races]). Use of other home COVID-19 tests differed by race and ethnicity (11.8% Black, 44.4% Hispanic, 45.8% White, 43.8% other races). Compared with White persons, Black persons were 72% less likely to use other home test kits (adjusted relative risk [aRR]=0.28; 95% CI=0.16-0.50). Provision of tests through this well-publicized program likely improved use of COVID-19 home testing and health equity in the United States, particularly among Black persons. National programs to address availability and accessibility of critical health services in a pandemic response have substantial health value.

Geospatial Prioritization to Reach Hispanic or Latino and Other Priority Populations Through HIV Home Testing Services.

Hispanic or Latino men who have sex with men (HLMSM) are disproportionately affected by the HIV/AIDS epidemic in New York State (NYS) and nationally. In 2019, HLMSM comprised 13% of all new diagnoses and 21% of new diagnoses among men who have sex with men (MSM) in NYS excluding New York City. HIV home testing programs are effective methods for increasing HIV testing. This pilot sought to determine whether the NYS HIV Home Test Giveaway (HHTG) can effectively reach priority populations, specifically HLMSM/transgender/gender nonconforming persons who have sex with men, to increase uptake of HIV home testing services and identify new HIV infections. We recruited participants using media campaigns linked to a brief self-administered eligibility survey. Eligible participants provided their e-mail address to receive a code for a free HIV home test and were sent a self-administered follow-up survey 4 to 11 weeks after eligibility survey completion. The 2018 and 2019 NYS HHTG reached 1214 and 1340 participants, respectively. A total of 606 participants in 2018 and 736 participants in 2019 were eligible to receive the HHTG home test kit. HHTG utilization and test results. Hispanic or Latino persons participated at higher rates (34.8% and 25.4% in 2018 and 2019, respectively) than the percentage of Hispanic men in prioritized zip codes (15.7% and 15.6% in 2018 and 2019, respectively). The majority of participants who received HHTG test kits used them to test themselves (87.5% in 2018 and 90.6% in 2019). Across both rounds, 4 participants reported new HIV-positive results, for a seropositivity rate of approximately 1%. Geospatial prioritization was successful in reaching Hispanic or Latino priority populations for HIV testing. HIV self-testing programs such as the HHTG are beneficial methods to reach priority populations for state and national Ending the HIV Epidemic initiatives.

Voluntary risk mitigation behaviour can reduce impact of SARS-CoV-2: a real-time modelling study of the January 2022 Omicron wave in England

BackgroundPredicting the likely size of future SARS-CoV-2 waves is necessary for public health planning. In England, voluntary “plan B” mitigation measures were introduced in December 2021 including increased home working and face coverings in shops but stopped short of restrictions on social contacts. The impact of voluntary risk mitigation behaviours on future SARS-CoV-2 burden is unknown.MethodsWe developed a rapid online survey of risk mitigation behaviours ahead of the winter 2021 festive period and deployed in two longitudinal cohort studies in the UK (Avon Longitudinal Study of Parents and Children (ALSPAC) and TwinsUK/COVID Symptom Study (CSS) Biobank) in December 2021. Using an individual-based, probabilistic model of COVID-19 transmission between social contacts with SARS-CoV-2 Omicron variant parameters and realistic vaccine coverage in England, we predicted the potential impact of the SARS-CoV-2 Omicron wave in England in terms of the effective reproduction number and cumulative infections, hospital admissions and deaths. Using survey results, we estimated in real-time the impact of voluntary risk mitigation behaviours on the Omicron wave in England, if implemented for the entire epidemic wave.ResultsOver 95% of survey respondents (NALSPAC = 2686 and NTwins = 6155) reported some risk mitigation behaviours, with vaccination and using home testing kits reported most frequently. Less than half of those respondents reported that their behaviour was due to “plan B”. We estimate that without risk mitigation behaviours, the Omicron variant is consistent with an effective reproduction number between 2.5 and 3.5. Due to the reduced vaccine effectiveness against infection with the Omicron variant, our modelled estimates suggest that between 55% and 60% of the English population could be infected during the current wave, translating into between 12,000 and 46,000 cumulative deaths, depending on assumptions about severity and vaccine effectiveness. The actual number of deaths was 15,208 (26 November 2021–1 March 2022). We estimate that voluntary risk reduction measures could reduce the effective reproduction number to between 1.8 and 2.2 and reduce the cumulative number of deaths by up to 24%.ConclusionsPredicting future infection burden is affected by uncertainty in disease severity and vaccine effectiveness estimates. In addition to biological uncertainty, we show that voluntary measures substantially reduce the projected impact of the SARS-CoV-2 Omicron variant but that voluntary measures alone would be unlikely to completely control transmission.

A quick test to objectify smell and taste dysfunction at home: a proof of concept for the validation of the chemosensory perception test.

Recent studies have shown the efficacy of a home test for the self-evaluation of olfactory and gustatory functions in quarantined coronavirus disease-2019 (COVID-19) patients. However, testing was often limited to COVID-19 participants, and the accuracy of home test kits was rarely compared to standardized testing. This study aims at providing proof of concept for the validation of the new Chemosensory Perception Test (CPT) developed to remotely assess orthonasal olfactory, retronasal olfactory, and gustatory functions in various populations using common North American household items. In the 2 experiments, a total of 121 participants irrespective of having olfactory and/or gustatory complaints from various causes (COVID-19, sinunasal, post-viral, idiopathic) were tested first, with one or many of the following tests: (i) a brief chemosensory questionnaire, (ii) an olfactory test-Sniffin' Sticks Test (SST) or University of Pennsylvania Smell Identification Test (UPSIT), and/or (iii) a gustatory test-Brief Waterless Empirical Taste Test (B-WETT). We then applied the CPT which yielded 3 different subscores, namely orthonasal, retronasal, and gustatory CPT scores. The orthonasal CPT score was significantly correlated with SST (ρ = 0.837, P < 0.001) and UPSIT (ρ = 0.364, P < 0.001) scores, and exhibited an excellent accuracy to identify olfactory dysfunction (OD) as compared to SST (area under the curve [AUC]: 0.923 [95% confidence interval {CI}, 0.822-1.000], P < 0.001). The retronasal CPT score but not the gustatory CPT score allowed to distinguish between participants with or without subjective gustatory complaint (AUC: 0.818 [95% CI, 0.726-0.909], P < 0.001). The CPT has the ability to identify OD and to quantify subjective gustatory complaints.

A Versatile Biomimic Nanotemplating Fluidic Assay for Multiplex Quantitative Monitoring of Viral Respiratory Infections and Immune Responses in Saliva and Blood.

The last pandemic exposed critical gaps in monitoring and mitigating the spread of viral respiratory infections at the point-of-need.A cost-effective multiplexed fluidic device (NFluidEX), as a home-test kit analogous to a glucometer,that uses saliva and blood for parallel quantitative detection of viral infection and body's immune response in an automated mannerwithin11 min is proposed.The technology integratesa versatile biomimetic receptor based on molecularly imprinted polymers in a core-shell structure with nano gold electrodes, a multiplexed fluidic-impedimetric readout, built-in saliva collection/preparation, and smartphone-enabled data acquisition and interpretation. NFluidEX is validated with Influenza A H1N1 and SARS-CoV-2 (original strain and variants of concern), and achieves low detection limit in saliva and blood for the viral proteins and the anti-receptor binding domain (RBD) Immunoglobulin G (IgG) and Immunoglobulin M (IgM), respectively. It is demonstrated that nanoprotrusions of gold electrodes are essential for the fine templating of antibodies and spike proteins during molecular imprinting, and differentiation of IgG and IgM in whole blood. In the clinical setting, NFluidEX achieves 100% sensitivity and 100% specificity by testing 44 COVID-positive and 25 COVID-negative saliva and blood samples on par with the real-time quantitative polymerase chain reaction (p < 0.001, 95% confidence) and the enzyme-linked immunosorbent assay.

Technology-Enabled Advances in Pain Management.

Technology-Enabled Advances in Pain Management.

A Critical Review on the Use of Molecular Imprinting for Trace Heavy Metal and Micropollutant Detection

Molecular recognition has been described as the “ultimate” form of sensing and plays a fundamental role in biological processes. There is a move towards biomimetic recognition elements to overcome inherent problems of natural receptors such as limited stability, high-cost, and variation in response. In recent years, several alternatives have emerged which have found their first commercial applications. In this review, we focus on molecularly imprinted polymers (MIPs) since they present an attractive alternative due to recent breakthroughs in polymer science and nanotechnology. For example, innovative solid-phase synthesis methods can produce MIPs with sometimes greater affinities than natural receptors. Although industry and environmental agencies require sensors for continuous monitoring, the regulatory barrier for employing MIP-based sensors is still low for environmental applications. Despite this, there are currently no sensors in this area, which is likely due to low profitability and the need for new legislation to promote the development of MIP-based sensors for pollutant and heavy metal monitoring. The increased demand for point-of-use devices and home testing kits is driving an exponential growth in biosensor production, leading to an expected market value of over GPB 25 billion by 2023. A key requirement of point-of-use devices is portability, since the test must be conducted at “the time and place” to pinpoint sources of contamination in food and/or water samples. Therefore, this review will focus on MIP-based sensors for monitoring pollutants and heavy metals by critically evaluating relevant literature sources from 1993 to 2022.

“Doing It on My Own Terms”: Transgender and Nonbinary Adults’ Experiences with HPV Self-Swabbing Home Testing Kits

The human papillomavirus (HPV) carries a significant health risk for people with a cervix. Among transgender and nonbinary people, however, testing and treatment for HPV can pose difficulties and even be traumatic at times. This study is part of a larger mixed-methods study conducted in Michigan in 2020, and it explores the experiences of transmasculine and nonbinary people with at-home self-swabbing HPV test kits and knowledge of HPV transmission/screenings. Phenomenological qualitative methods were used by conducting virtual qualitative interviews with ten transmasculine and nonbinary individuals with cervixes, ages 23–59. Interviews were independently coded by members of the research team and a tabletop theming method was used. Four themes were generated from the data: (1) multilevel barriers; (2) “get it done, so I know that I am safe”; (3) contrasting preferences for care; and (4) community calls for change. The discussion focuses on the implications of these findings for improving sexual health care for the transgender and nonbinary community, along with directions for further research.

O-160 Can a mobile app address reproductive e-literacy?

Study questionCan a mobile app be developed to address reproductive e-literacy?Summary answerA mobile app has been developed with the features identified by patients as important to their reproductive e-literacy.What is known alreadyOne main factor that impacts fertility treatment seeking and decision-making is the knowledge people have regarding fertility health.The more relevant information people have, the better they are equipped to deal with and manage their diagnosis.Virtual communication is a common, yet complex, source of information. In digital tools, patients look for educational content, for emotional support, for a sense of community, the opportunity to build support networks, and for trustworthiness, with proper references. Nevertheless, there are reproductive e-literacy inequalities between subgroups. Study design, size, durationA triad of studies supported the development of the a mobile app, between 2018 and 2020:2018 - Interviews and focus groups (N = 27)2019 - Intervention (N = 10)2020 - Clinical trial (N = 24 control group ; N = 33 intervention group)Participants/materials, setting, methods2018 - Interviews and focus groups (N = 27) to explore the topic of reproductive e-literacy.2019 - Intervention (N = 10) to assess usage of the programme over 3 months, regarding support, ability to cope, recommending it to others, and continued engagement.2020 - Clinical trial (N = 24 control group; N = 33 intervention group) survey to assess patients’ major concerns and how their ability to cope changes according to perceived support.Main results and the role of chanceThe app developed, to respond to the features identified in the triad of clinical studies.The app includes an online course with five modules that explain fertility-related topics in an accessible way, twenty two interventions and fifteen mindfulness recordings that users can access and use at home whenever they need, cognitive behavioural therapy exercises (compiled in a workbook), the Fertility Risk Detection Tool - a questionnaire of 90 questions that accesses both the male and the female health -, ability to join support groups, book one-to-one consultations, buy at home test kits, and a questionnaire to help the user find the best fertility clinic for them. An advisory board with clinicians, experts and patients, provides insights into required changes to content overtime to make sure it continues to meet the needs of patients as well as the advancements in medical knowledge.Limitations, reasons for cautionThe authors are aware of the limitations and reason for caution with this study. A total of 94 patients participated in the triad of studies. Confounding factors, such as coronavirus pandemic, may also contribute to concerns around reproductive future uncertainty and different needs of support and information.Wider implications of the findingsThe findings are aligned with previous insights that mention patients look for educational content, emotional support, a sense of community, the opportunity to build support networks, and for trustworthiness, with proper references.Trial registration numbernot applicable

A hands-free stool sampling system for monitoring intestinal health and disease

Analysis of stool offers simple, non-invasive monitoring for many gastrointestinal (GI) diseases and access to the gut microbiome, however adherence to stool sampling protocols remains a major challenge because of the prevalent dislike of handling one’s feces. We present a technology that enables individual stool specimen collection from toilet wastewater for fecal protein and molecular assay. Human stool specimens and a benchtop test platform integrated with a commercial toilet were used to demonstrate reliable specimen collection over a wide range of stool consistencies by solid/liquid separation followed by spray-erosion. The obtained fecal suspensions were used to perform occult blood tests for GI cancer screening and for microbiome 16S rRNA analysis. Using occult blood home test kits, we found overall 90% agreement with standard sampling, 96% sensitivity and 86% specificity. Microbiome analysis revealed no significant difference in within-sample species diversity compared to standard sampling and specimen cross-contamination was below the detection limit of the assay. Furthermore, we report on the use of an analogue turbidity sensor to assess in real time loose stools for tracking of diarrhea. Implementation of this technology in residential settings will improve the quality of GI healthcare by facilitating increased adherence to routine stool monitoring.

Scheduling Diagnostic Testing Kit Deliveries with the Mothership and Drone Routing Problem.

A critical component in the public health response to pandemics is the ability to determine the spread of diseases via diagnostic testing kits. Currently, diagnostic testing kits, treatments, and vaccines for the COVID-19 pandemic have been developed and are being distributed to communities worldwide, but the spread of the disease persists. In conjunction, a strong level of social distancing has been established as one of the most basic and reliable ways to mitigate disease spread. If home testing kits are safely and quickly delivered to a patient, this has the potential to significantly reduce human contact and reduce disease spread before, during, and after diagnosis. This paper proposes a diagnostic testing kit delivery scheduling approach using the Mothership and Drone Routing Problem (MDRP) with one truck and multiple drones. Due to the complexity of solving the MDRP, the problem is decomposed into 1) truck scheduling to carry the drones and 2) drone scheduling for actual delivery. The truck schedule (TS) is optimized first to minimize the total travel distance to cover patients. Then, the drone flight schedule is optimized to minimize the total delivery time. These two steps are repeated until it reaches a solution minimizing the total delivery time for all patients. Heuristic algorithms are developed to further improve the computational time of the proposed model. Experiments are made to show the benefits of the proposed approach compared to the commonly performed face-to-face diagnosis via the drive-through testing sites. The proposed solution method significantly reduced the computation time for solving the optimization model (less than 50 minutes) compared to the exact solution method that took more than 10 hours to reach a 20% optimality gap. A modified basic reproduction rate (i.e., mR0) is used to compare the performance of the drone-based testing kit delivery method to the face-to-face diagnostic method in reducing disease spread. The results show that our proposed method (mR0= 0.002) outperformed the face-to-face diagnostic method (mR0= 0.0153) by reducing mR0 by 7.5 times.

Reliability, usability and identified need for home-based cardiometabolic health self-assessment during the COVID-19 pandemic in Soweto, South Africa

A major obstacle to tackling the growing burden of chronic disease in South Africa is lack of testing, particularly where individuals face multiple barriers to accessing health services. We conducted a pilot study to evaluate a cardiometabolic self-measurement kit, including assessment of blood pressure, obesity and urine analysis, amongst adults in Soweto, South Africa. Participants (N = 94) were recruited by researchers during community health screening and were provided with a home test kit including a tablet with self-measurement instructions. The participants entered their results on the tablet and, on completion, the researcher immediately repeated the measurements. We interviewed 10% of participants to understand their experience and views of the kits. Concordance correlation coefficients ranged from 0.78 for waist circumference to 0.93 for height, while the overall percentage agreement ranged from 80.5% for both urine protein and urine glucose testing to 91.4% for the identification of central obesity (ratio of waist circumference to height of ≥ 0.5). Participants saw the need for self-testing and found the process for the most part simple, though urine testing and height self-assessment presented some challenges. This pilot study suggests that self-assessment at home has the potential to facilitate the identification of individuals at risk for cardiometabolic disease in low-income settings, adding to a growing body of evidence on the use of self-testing in disease prevention and detection. However, we would not recommend self-testing for urine glucose and protein without further study.

Increasing uptake to a lung cancer screening programme: building with communities through co-design

BackgroundLung cancer is the most common cause of cancer death in the UK. Low-dose computed tomography (LDCT) screening has been shown to identify lung cancer at an earlier stage. A risk stratified approach to LDCT referral is recommended. Those at higher risk of developing lung cancer (aged 55 + , smoker, deprived area) are least likely to participate in such a programme and, therefore, it is necessary to understand the barriers they face and to develop pathways for implementation in order to increase uptake.MethodsA 2-phased co-design process was employed to identify ways to further increase opportunity for uptake of a lung cancer screening programme, using a risk indicator for LDCT referral, amongst people who could benefit most. Participants were members of the public at high risk from developing lung cancer and professionals who may provide or signpost to a future lung cancer screening programme. Phase 1: interviews and focus groups, considering barriers, facilitators and pathways for provision. Phase 2: interactive offline booklet and online surveys with professionals. Qualitative data was analysed thematically, while descriptive statistics were conducted for quantitative data.ResultsIn total, ten barriers and eight facilitators to uptake of a lung cancer screening programme using a biomarker blood test for LDCT referral were identified. An additional four barriers and four facilitators to provision of such a programme were identified. These covered wider themes of acceptability, awareness, reminders and endorsement, convenience and accessibility. Various pathway options were evidenced, with choice being a key facilitator for uptake. There was a preference (19/23) for the provision of home test kits but 7 of the 19 would like an option for assistance, e.g. nurse, pharmacist or friend. TV was the preferred means of communicating about the programme and fear was the most dominant barrier perceived by members of the public.ConclusionCo-design has provided a fuller understanding of the barriers, facilitators and pathways for the provision of a future lung cancer screening programme, with a focus on the potential of biomarker blood tests for the identification of at-risk individuals. It has also identified possible solutions and future developments to enhance uptake, e.g. Embedding the service in communities, Effective communication, Overcoming barriers with options. Continuing the process to develop these solutions in a collaborative way helps to encourage the personalised approach to delivery that is likely to improve uptake amongst groups that could benefit most.

Secondary attack rates in primary and secondary school bubbles following a confirmed case: Active, prospective national surveillance, November to December 2020, England.

BackgroundFollowing the full re-opening of schools in England and emergence of the SARS-CoV-2 Alpha variant, we investigated the risk of SARS-CoV-2 infection in students and staff who were contacts of a confirmed case in a school bubble (school groupings with limited interactions), along with their household members.MethodsPrimary and secondary school bubbles were recruited into sKIDsBUBBLE after being sent home to self-isolate following a confirmed case of COVID-19 in the bubble. Bubble participants and their household members were sent home-testing kits comprising nasal swabs for RT-PCR testing and whole genome sequencing, and oral fluid swabs for SARS-CoV-2 antibodies.ResultsDuring November-December 2020, 14 bubbles were recruited from 7 schools, including 269 bubble contacts (248 students, 21 staff) and 823 household contacts (524 adults, 299 children). The secondary attack rate was 10.0% (6/60) in primary and 3.9% (4/102) in secondary school students, compared to 6.3% (1/16) and 0% (0/1) among staff, respectively. The incidence rate for household contacts of primary school students was 6.6% (12/183) and 3.7% (1/27) for household contacts of primary school staff. In secondary schools, this was 3.5% (11/317) and 0% (0/1), respectively. Household contacts were more likely to test positive if their bubble contact tested positive although there were new infections among household contacts of uninfected bubble contacts.InterpretationCompared to other institutional settings, the overall risk of secondary infection in school bubbles and their household contacts was low. Our findings are important for developing evidence-based infection prevention guidelines for educational settings.