Preferences of health care workers using tongue swabs for tuberculosis diagnosis during COVID-19

Abstract

Healthcare workers (HCW) who come into contact with tuberculosis (TB) patients are at elevated risk of TB infection and disease. The collection and handling of sputum samples for TB diagnosis poses exposure risks to HCW, particularly in settings where aerosol containment is limited. An alternative sample collection method, tongue swabbing, was designed to help mitigate this risk, and is under evaluation in multiple settings. This study assessed risk perceptions among South African HCW who used tongue swabbing in TB diagnostic research during the COVID-19 pandemic. We characterized their context-specific preferences as well as the facilitators and barriers of tongue swab use in clinical and community settings. Participants (n=18) were HCW with experience using experimental tongue swabbing methods at the South African Tuberculosis Vaccine Initiative (SATVI). We used key informant semi-structured interviews to assess attitudes toward two tongue swab strategies: Provider-collected swabbing (PS) and supervised self-swabbing (SSS). Responses from these interviews were analyzed by rapid qualitative analysis and thematic analysis methods. Facilitators included aversion to sputum (PS and SSS), perceived safety of the method (SSS), and educational resources to train patients (SSS). Barriers included cultural stigmas, as well as personal security and control of their work environment when collecting swabs in community settings. COVID-19 risk perception was a significant barrier to the PS method. Motivators for HCW use of tongue swabbing differed substantially by use case, and whether the HCW has the authority and agency to implement safety precautions in specific settings. These findings point to a need for contextually specific educational resources to enhance safety of and adherence to the SSS collection method.

Tongue swab testing on two automated tuberculosis diagnostic platforms, Cepheid Xpert® MTB/RIF Ultra and Molbio Truenat® MTB Ultima

“…Participants swabbed themselves under the supervision of study workers during home visits. The protocols for provider-collected swabs and supervised self-swabbing are provided elsewhere (19). After the swab was collected, either the study worker or the participant placed the swab into an empty 2-mL screw-cap tube (Sarstedt, 72.694.106) held by the study worker.…”

“…Tongue swabbing is fast, painless, and does not require specific infrastructure for privacy or infectious aerosol control. Everyone, including children and people living with HIV (PLWH), can be easily swabbed in any setting (18, 19).…”

“…First, the previous study used swabs that were collected (either singly or in tandem) into 2-mL storage/transport tubes that were pre-filled with a sterile buffer, whereas this study used single swabs that were collected, cold-stored, and transported dry in 2-mL tubes, without buffer. Dry collection and storage may be more user-friendly for patients and providers, especially in community (non-clinical) settings (19). Second, the current study used a streamlined protocol for swab sample processing (about 15 minutes from sample tube to start of test, compared to 45 to 60 minutes for the methods described previously (6)).…”

High-sensitivity detection ofMycobacterium tuberculosisDNA in tongue swab samples

“…Tongue swabbing is fast, painless, and does not require facilities for privacy or aerosol control. In a recent study of user preference, most health care workers expressed their preference for swabbing over sputum collection (13). Individuals who may struggle to produce sputum, such as children and people living with HIV (PLHIV), can easily provide swabs in any setting.…”