A multistage mixed-methods evaluation protocol for the national testing response during the COVID-19 pandemic in England

Naidoo, Reshania; Andersen-waine, Billie; Dahal, Prabin; Dickinson, Sophie; Lambert, Ben; Mills, Melinda; Molyneux, Sassy; Rowe, Emily; Pinto-Duschinsky, Sarah; Stepniewska, Kasia; Shretta, Rima; Voysey, Merryn; Wanat, Marta; Yenidogan, Gulsen; White, Lisa J.

doi:10.1101/2022.10.27.22281604

Cited by 4 publications

(4 citation statements)

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“…This scoping study was nested in a broader rapid scoping review of barriers and facilitators to engaging with the COVID-19 testing programme, covering testing, reporting and self-isolation behaviour in the UK. This in turn formed part of a mixed-method programme of work conducted by the EY-Oxford Health Analytics Consortium, aimed at evaluating the UK Health Security Agency’s (UKHSA’s) COVID-19 testing strategy in England—the protocol and report are available online 5 11…”

Section: Methodsmentioning

confidence: 99%

Decision to self-isolate during the COVID-19 pandemic in the UK: a rapid scoping review

Keene,

Dickinson,

Naidoo

et al. 2024

BMJ Open

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ObjectiveTesting for COVID-19 was a key component of the UK’s response to the COVID-19 pandemic. This strategy relied on positive individuals self-isolating to reduce transmission, making isolation the lynchpin in the public health approach. Therefore, we scoped evidence to systematically identify and categorise barriers and facilitators to compliance with self-isolation guidance during the COVID-19 pandemic in the UK, to inform public health strategies in future pandemics.DesignA rapid scoping review was conducted.Search strategyKey terms were used to search literature databases (PubMed, Scopus and the WHO COVID-19 Research Database, on 7 November 2022), Google Scholar and stakeholder-identified manuscripts, ultimately including evidence published in English from UK-based studies conducted between 2020 and 2022.Data extraction and synthesisData were extracted and synthesised into themes, organised broadly into capability, opportunity and motivation, and reviewed with key stakeholders from the UK Health Security Agency (UKHSA).ResultsWe included 105 sources, with 63 identified from UKHSA and used to inform their decision-making during the pandemic. Influences on the decision to comply with isolation guidance were categorised into six themes: perceived ability to isolate; information and guidance; logistics; social influences, including trust; perceived value; and perceived consequences. Individuals continuously assessed these factors in deciding whether or not to comply with guidance and self-isolate.ConclusionsDecisions to self-isolate after a positive test were influenced by multiple factors, including individuals’ beliefs, concerns, priorities and personal circumstances. Future testing strategies must facilitate meaningful financial, practical and mental health support to allow individuals to overcome the perceived and actual negative consequences of isolating. Clear, consistent communication of the purpose and procedures of isolating will also be critical to support compliance with self-isolation guidance, and should leverage people’s perceived value in protecting others. Building public trust is also essential, but requires investment before the next pandemic starts.

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Section: Methodsmentioning

confidence: 99%

Decision to self-isolate during the COVID-19 pandemic in the UK: a rapid scoping review

Keene,

Dickinson,

Naidoo

et al. 2024

BMJ Open

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“…LFD test volume data obtained via England’s Pillar 1 and Pillar 2 testing programmes [11] from 1 October 2020 to 30 March 2022 in healthcare settings were provided by UKHSA, in the context of a retrospective evaluation of England’s COVID-19 testing policy [12, 13]. Only data from NHS acute trusts were identifiable in both datasets, so only these data from the healthcare sector were analysed.…”

Section: Methodsmentioning

confidence: 99%

Assessing the impact of testing for COVID-19 using lateral flow devices in NHS acute trusts in England

Chen,

Hounsell,

Cantrell

et al. 2024

Preprint

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BackgroundTwice-weekly lateral flow device (LFD) testing was introduced for routine asymptomatic testing of healthcare workers (HCWs) in the National Health Service (NHS) in England in November 2020, with the primary aim of reducing nosocomial infections among staff and patients and a secondary aim of reducing absenteeism among HCWs. Here, we describe the burdens of HCW absenteeism and nosocomial infections in NHS acute trusts and the reported testing intensity of LFDs and associated costs from October 2020 to March 2022 and assess the impact of LFD testing on reducing these burdens.Methods and FindingsWe collected 16 million LFD testing results (total cost GBP 1.64 billion) reported in NHS acute trusts through England’s Pillar 1 and 2 testing programmes from 1 October 2020 to 30 March 2022. We estimated the prevalence of nosocomial COVID-19 infections in NHS acute trusts using data from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC). Testing data were linked with nosocomial infections and full-time equivalent (FTE) days lost by trust for NHS acute trusts.We used a mixed-effects linear model to examine the association between FTE days lost and LFD test coverage. The relationship between weekly prevalence of nosocomial infections and LFD test coverage in the previous week was modelled using logistic regression weighted by the number of new COVID-19 cases reported in the ISARIC dataset for that week. We adjusted both models for community prevalence of COVID-19 infections, average income deprivation score, prevalence of variants of concern and LFD test positivity.FTE days lost among HCWs varied considerably by trust type, staff group, geographical location of trusts, and progress of the pandemic in England. Increased LFD test coverage was associated with decreases in FTE days lost due to COVID-19 from November 2020 to July 2021, with no association observed from August 2021 to March 2022. Higher community prevalence levels were associated with significant increases in FTE days lost due to COVID-19 in all periods except the pre-vaccination period (last two months of 2020). The model predicted that changes in testing levels (50–150%) would have resulted in modest changes in FTE days lost due to COVID-19 for all time periods.We identified 3,794 nosocomial infections (if patients developed COVID-19 symptoms 7 days or more after their hospital admission) among 106,377 hospitalised COVID-19 patients in 136 NHS acute trusts. The proportion of nosocomial infections among new weekly cases in hospitalised patients was negatively associated with reported LFD testing levels. The strength of the association varied over time and was estimated to be highest during the Omicron period, although no effect of testing on HCW absenteeism was found. The observed HCW testing/reporting was estimated to be associated with a 16.8% (95% confidence interval 8.2%, 18.8%) reduction in nosocomial infections compared with a hypothetical testing scenario at 25% of actual levels, translating to a cost saving per quality-adjusted life-year (QALY) gained of GBP 18,500–46,400.ConclusionsLFD testing was an impactful public health intervention for reducing HCW absenteeism and nosocomial infections in NHS acute trusts and was cost effective in preventing nosocomial infections.Author SummaryWhy was this study done?In any pandemic response, mass diagnostic testing plays a key role.We sought to evaluate the burdens of healthcare worker absenteeism and nosocomial infections in NHS acute trusts, the reported testing intensity using lateral flow devices (LFDs) and associated costs, and the impact of LFD testing on reducing these burdens.What did the researchers do and find?We collected 16 million LFD testing results and full-time equivalent (FTE) days lost due to COVID-19, obtained from healthcare workers (HCWs) in NHS acute trusts in England between 1 October 2020 and 30 March 2022.We estimated the number of nosocomial COVID-19 infections in NHS acute trusts using data from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC).Testing data were linked with nosocomial infections and FTE days lost due to COVID-19 by trust for NHS acute trusts.We used a mixed-effects linear model to examine the association between FTE days lost due to COVID-19 and LFD test coverage and applied a logistic regression to assess the association between nosocomial infections and LFD test coverage.We found that LFD testing in the healthcare setting was an impactful public health intervention.LFD testing reduced HCW absenteeism and nosocomial infections in NHS acute trusts; it was also cost effective in preventing nosocomial infections.What do these findings mean?Our analysis of the available data indicated that testing HCWs had varying impacts (on both nosocomial infections and HCW FTE days lost due to COVID-19) throughout the pandemic, possibly influenced by external factors such as community prevalence and vaccination.In any future pandemic, HCW testing interventions should incorporate collection of and/or timely access to relevant data, including HCW absenteeism, routine test results, community prevalence, and hospitalisation and mortality data.The lessons learnt from this study could be used by relevant authorities to support the real-time assessment of any testing service and adjustment of the testing regimen; they could also be used to help develop more targeted and agile testing systems, which operationally would require the ability to turn mass testing off and on as an epidemic progressed.

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“…The testing data were provided by UKHSA in the context of a retrospective evaluation of the delivery of England’s COVID-19 testing programme and its impact on public health outcomes 11 . Our analysis period covered 1 st October 2020 - 30 th March 2022.…”

Section: Methodsmentioning

confidence: 99%

Understanding COVID-19 testing behaviour in England through a sociodemographic lens

Bajaj,

Chen,

Creswell

et al. 2023

Preprint

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BackgroundUnderstanding underlying mechanisms of heterogeneity in test-seeking and reporting behaviour can help to protect the vulnerable and guide equity-driven interventions. Using COVID-19 testing data for England and data from community prevalence surveillance surveys (REACT-1 and ONS-CIS) from October 2020 to March 2022, we investigated the relationship between sociodemographic factors and testing behaviours in England.MethodsWe used mass testing data for lateral flow device (LFD; data for 290 million tests performed and reported) and polymerase chain reaction (PCR) (data for 107 million tests performed and returned from the laboratory) tests made available for the general public, provided by date, self-reported age and ethnicity at lower tier local authority (LTLA) level. Using a mechanistic causal model to debias the PCR testing data, we obtained estimates of weekly SARS-CoV-2 prevalence by self-reported ethnic groups and age groups for LTLAs in England. This approach to debiasing the PCR (or LFD) testing data also estimated a testing bias parameter defined as the odds of testing in infected versus not infected individuals, which would be close to zero if the likelihood of test seeking (or seeking and reporting) was the same regardless of infection status. Using confirmatory PCR data, we estimated false positivity rates, sensitivity, specificity, and the rate of decline in detection probability by PCR by sociodemographic groups. We also estimated the daily incidence allowing us to determine the fraction of cases captured by the testing programme.FindingsFrom March 2021 onwards, individuals in the most deprived regions reported approximately half as many LFD tests per-capita than those in the least deprived areas (Median ratio [Inter quartile range, IQR]: 0·50 [0·44, 0·54]). During October 2020 – June 2021, PCR testing patterns were in the opposite direction (Median ratio [IQR]: 1·8 [1·7, 1·9]). Infection prevalences in Asian or Asian British communities were considerably higher than those of other ethnic groups during the Alpha and Omicron BA.1 waves. Our estimates indicate that the England COVID-19 testing program detected 26% - 40% of all cases (including asymptomatic cases) over the study period with no consistent differences by deprivation levels or ethnic groups.PCR testing biases were generally higher than for LFDs, which was in line with the general policy of symptomatic and asymptomatic use of these tests. During the invasion phases of the Delta and Omicron variants of concern, the PCR testing bias in the most deprived populations was roughly double (ratio: 2·2 and 2·7 respectively) that in the least. We also determined that ethnic minorities and older individuals were less likely to use confirmatory PCR tests through most of the pandemic and that there was possibly a longer delay in reporting a positive LFD test in the Black populations.InterpretationDifferences in testing behaviours across sociodemographic groups may be reflective of the relatively higher costs of self-isolation to vulnerable populations, differences in test accessibility, digital literacy, and differing perception about the utility of tests and risks posed by infection. Our work shows how mass testing data can be used in conjunction with surveillance surveys to identify gaps in the uptake of public health interventions at fine scale levels and by sociodemographic groups. It provides a framework for monitoring local interventions and yields valuable lessons for policy makers in ensuring an equitable response to future pandemics.FundingUK Health Security Agency.

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A multistage mixed-methods evaluation protocol for the national testing response during the COVID-19 pandemic in England

Cited by 4 publications

References 36 publications

Decision to self-isolate during the COVID-19 pandemic in the UK: a rapid scoping review

Decision to self-isolate during the COVID-19 pandemic in the UK: a rapid scoping review

Assessing the impact of testing for COVID-19 using lateral flow devices in NHS acute trusts in England

Understanding COVID-19 testing behaviour in England through a sociodemographic lens

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