COVID-19 self-testing in Nigeria: Stakeholders’ opinions and perspective on its value for case detection

Abstract

Background COVID-19 testing coverage is limited in Nigeria. Access to SARS-CoV-2 self-testing kits may help improve the detection of asymptomatic and mildly symptomatic cases and increase the currently low rate of COVID-19 testing in the country. Before implementing SARS-CoV-2 self-testing in Nigeria, it is imperative to assess the populations perceptions regarding this innovation. We therefore conducted a qualitative study to investigate peoples values and preferences for SARS-CoV-2 self-testing in Nigeria. Methods We used semi-structured interviews and focus group discussions among healthcare workers, community representatives, and public health implementors to explore values and perceptions around various aspects of COVID-19 testing, including conventional COVID-19 testing, SARS-CoV-2 self-testing, the safe and effective use of SARS-CoV-2 self-testing, actions upon receiving a positive SARS-CoV-2 self-test result, and future prospects for SARS-CoV-2 self-testing. Results Respondents reported that there is limited availability of conventional SARS-CoV-2 testing in Nigeria. While just a few respondents were familiar with SARS-CoV-2 testing, respondents generally supported the use of SARS-CoV-2 self-testing as they felt it could assist with early case detection and improve access to testing. Concerns relating to the use of SARS-CoV-2 self-testing were majorly about the ability among low literacy populations to use and interpret the test, the affordability of tests, equity of access, and the availability of healthcare system support for those who test positive. Conclusion Though the public perceive multiple benefits associated with access to SARS-CoV-2 self-testing, the efficiency of the national health service delivery system may limit access of the users of the kits to psychosocial and clinical support. In Nigeria, where COVID-19 vaccine coverage is low and the risk of further waves of COVID-19 is high, self-testing may assist in the prompt detection of cases and contribute to halting the spread of the virus.

Self-Testing for COVID-19 in São Paulo, Brazil: Results of a Population-Based Values and Attitudes Survey

“…In our inquiry, acceptability was conceptualized as a composite of the public's values toward self-testing, including agreement with the concept of self-testing (73.91% and 60.09% of female and male respondents were in agreement, respectively); willingness to pay for self-testing (mean of 5.64 USD (SD 4.73) for the 69% of respondents who would pay for a self-test device); willingness to serially self-test (44.57% of females and 39.48% of males expressed a willingness to perform weekly self-tests if they were provided free of charge and recommended by health authorities); and likelihood to use self-testing (12.95% and 36.21% of respondents were "very likely" or "likely", respectively, to use a self-test when needed). Although satisfactory, the rates of likelihood to use a self-test were not as high as those found in Indonesia [26] or Nigeria [27], other countries where surveys of people's values and attitudes in relation to self-testing have been conducted using the same methodology as used for the survey presented here.…”

“…If social safety nets are not provided, self-isolation and reporting of a COVID-19 infection might be neither feasible nor desirable for affected people. As other self-testing studies in Indonesia and Nigeria have suggested, self-isolation might only be guaranteed if there are provisions in place to ensure that those who use a self-test do not lose their job or social position[26,27].…”

Acceptability and Willingness of UAE Residents to Use OTC Vending Machines to Deliver Self-Testing Kits for COVID-19 and the Implications

“…8,9,17,18 However, there were concerns with the ability of LMICs to rapidly scale up the detection of SARS-CoV-2 using real-time reverse transcription polymerase chain reaction (RT-PCR) testing with often few fully equipped laboratories in the early stages of the pandemic, available resources to purchase reagents as well as potential stock-outs of reagents. [19][20][21] In addition, concerns among the public, especially in LMICs, about accessing RT-PCR testing facilities, especially if this involves interacting with patients with COVID-19, potentially travelling long distances to access testing sites with associated time and cost implications and conflicts with work schedules, as well as a lack of privacy. [22][23][24] The concept of self-testing with rapid, lateral flow, SARS-CoV-2 antigen detection tests (RADT) helps to address these concerns, 13,19,[22][23][24] building on existing strategies for patients with diabetes as well as those with HIV, hepatitis C, malaria, and syphilis, testing themselves at home.…”

“…[19][20][21] In addition, concerns among the public, especially in LMICs, about accessing RT-PCR testing facilities, especially if this involves interacting with patients with COVID-19, potentially travelling long distances to access testing sites with associated time and cost implications and conflicts with work schedules, as well as a lack of privacy. [22][23][24] The concept of self-testing with rapid, lateral flow, SARS-CoV-2 antigen detection tests (RADT) helps to address these concerns, 13,19,[22][23][24] building on existing strategies for patients with diabetes as well as those with HIV, hepatitis C, malaria, and syphilis, testing themselves at home. 13,19,[25][26][27][28][29][30] The benefits of self-testing at home included greater uptake, ability to test at scale, efficiency with for instance no additional staff and personal protective equipment (PPE) involved, increased privacy reducing the potential for possible stigma, lack of contact with possible patients with COVID-19 in healthcare facilities as well as convenience.…”

“…[22][23][24] The concept of self-testing with rapid, lateral flow, SARS-CoV-2 antigen detection tests (RADT) helps to address these concerns, 13,19,[22][23][24] building on existing strategies for patients with diabetes as well as those with HIV, hepatitis C, malaria, and syphilis, testing themselves at home. 13,19,[25][26][27][28][29][30] The benefits of self-testing at home included greater uptake, ability to test at scale, efficiency with for instance no additional staff and personal protective equipment (PPE) involved, increased privacy reducing the potential for possible stigma, lack of contact with possible patients with COVID-19 in healthcare facilities as well as convenience. 21,25,[31][32][33][34] Published studies have demonstrated that RADTs correctly rule out infections with SARS-CoV-2 in up to 99.5% of the people with symptoms and 98.9% of the people without symptoms.…”