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 questionnaire 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.

SARS-CoV-2 self-testing in Peru: a cross-sectional survey of values and attitudes of the general population

“…There might be other predictors of non-compliance which this survey has failed to identify. Barriers to linkage to care identified by other qualitative studies on SARS-CoV-2 self-testing include fear of stigma, healthcare workers’ negative attitudes, cost of healthcare or denialism of the disease 25 32 33. In our study context, future research will be needed to understand how to ensure barriers to access healthcare do not deter Peruvians to report a positive self-test and request confirmatory testing, as well as to measure the impact of SARS-CoV-2 self-testing in case detection and pandemic control.…”

“…In Germany, 89.3% of teachers (n=711) invited to participate in a school-based pilot project accepted to use self-testing and submit their results for evaluation. Qualitative research has also provided evidence of acceptability of self-testing among minoritised groups, such as black/ African Americans in the USA, 32 or among inhabitants of remote rural areas in South Africa. 25 In essence, this study adds to the literature of acceptability studies in low-income and middle-income countries (LMICs).…”

COVID-19 self-testing: Countries accelerating policies ahead of WHO guidelines during pandemics, a global consultation

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

Self-tests for COVID-19: What is the evidence? A living systematic review and meta-analysis (2020–2023)

“…COVIDST facilitators assessed in twelve studies included self-test training prior to use, non-intrusive and ease of testing at-home, increased sense of safety, detailed self-test instructions, faster turnaround time, and instructional videos [23,28,32,57,61,62,66,68,70,[75][76][77][78][79].…”