Perceptions of COVID-19 Self-Testing and Recommendations for Implementation and Scale up Among Black/African Americans: Implications for the COVID-19 STEP Project

Abstract

Background COVID-19 self-testing (ST) is an innovative strategy with the potential to increase the access and uptake of testing and ultimately to limit the spread of the virus. To maximize the uptake and reach of this promising strategy and inform intervention development and scale up, research is needed to understand the acceptability of and willingness to use this tool. This is vital to ensure that Black/African Americans are reached by the Biden-Harris Administration’s free national COVID-19 ST program. This study aimed to explore the acceptability and recommendations to promote and scale up the uptake of COVID-19 ST among Black/African Americans. Methods We conducted a cross-sectional qualitative study using a semi-structured survey to assess barriers and facilitators to the uptake of COVID-19 ST among a convenience sample of 28 self-identified Black/African Americans from schools, community centers, and faith-based institutions in Ohio and Maryland. Inductive content analysis was conducted to identify categories and subcategories related to acceptability and recommendations for implementing and scaling up COVID-19 ST in communities. Results Participants perceived COVID-19 self-testing as an acceptable tool that is beneficial to prevent transmission and address some of the barriers associated with health facility testing, such as transportation cost and human contact at the health facility. However, concerns were raised regarding the accurate use of the kits and costs. Recommendations for implementing and scaling up COVID-19 ST included engagement of community stakeholders to disseminate information about COVID-19 self-testing and creating culturally appropriate education tools to promote knowledge of and clear instructions about how to properly use COVID-19 ST kits. Based on these recommendations, the COVID-19 STEP (Self-Testing Education and Promotion) Project is being developed and will involve engaging community partners such as barbers, church leaders, and other community-based organizations to increase the uptake and use of free COVID-19 ST kits among Black/African Americans. Conclusion Findings showed that most participants considered COVID-19 ST valuable for encouraging COVID-19 testing. However, cost and accuracy concerns may pose barriers. Future work should consider implementing interventions that leverage the benefits of COVID-19 ST and further assess the extent to which these identified facilitators and barriers may influence COVID-19 ST uptake.

Evaluation of Covid-19 Ag-RDTs self-testing in Lesotho and Zambia

“…Regarding acceptability, in Zambia the refusal rate was very low (1%) and most participants indicated that they would be willing to conduct a self-test in the future and would recommend self-testing to a friend or family member. This observation is consistent with other studies showing high acceptability of self-tests for COVID-19 (8)(9)(10)(11)(12)(13)(14) and for other diseases (7). Studies on acceptability and willingness to self-test in LMIC showed that the general population, health workers, civil society and potential implementers, are supportive of the use of self-tests quite consistently across different countries (13).…”

“…Ag-RDT self-testing as a potential testing strategy appears both feasible (5)(6)(7)(8) and acceptable (8)(9)(10)(11)(12)(13)(14).…”

COVID-19 self-testing: Countries accelerating policies ahead of WHO guidelines during pandemics: A Global Survey

“…failure to report results, and failure to present for confirmatory testing must be taken into consideration when developing national C19ST strategies or policies. Other studies resonate similar challenges on self-testing observed(8,15) from other disease program particularly HIV.…”

“…Antigen tests offer the possibility of rapid, inexpensive detection of SARS-COV-2 (14). Community engagement with relevant stakeholders is crucial to successful COVID-19 implementation and scale up (6,15,16). Such community-led approaches have been found to be highly effective when adapted for HIV self-testing (17), and should be considered and adapted as part of future pandemic preparedness plans (18).…”

Evaluation of COVID-19 antigen rapid diagnostic tests for self-testing in Lesotho and Zambia

“…Ag-RDT self-testing as a potential testing strategy appears both feasible [5][6][7][8] and acceptable [8][9][10][11][12][13][14][15][16]. However, most of the evidence comes from high-and middle-income settings and there is very little evidence from SSA or other low and middle income areas [3,4,17].…”