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

Abstract

Background Brazil is among the countries in South America where the COVID-19 pandemic has hit the general population hardest. Self-testing for SARS-CoV-2 infection is one of the community-based strategies that could help asymptomatic individuals at-risk of COVID-19, as well as those living in areas that are difficult for health personnel to reach, to know their infectious status and contribute to impeding further transmission of the virus. Methods A population-based survey was conducted in November 2021, to assess the acceptability of rapid SARS-CoV-2 antigen self-testing among the population of São Paulo. Survey respondents were approached at more than 400 different street-points that were randomly selected using a five-stage randomization process. A 35-item structured questionnaire was used. Dependent variables for our analyses were the likelihood to use and willingness to pay for self-testing, and the likelihood of taking preventive measures to prevent onward transmission of COVID-19 following a reactive self-test result. Bivariate and multivariate regression analyses were performed. Results Overall,417 respondents (44.12% female) participated; 19.66% had previously had COVID-19 disease. A minority (9.59%) felt at high-risk of COVID-19. The majority of both females and males (73.91% and 60.09%, respectively) were in favor of the idea of COVID-19 self-testing. Overall, if self-tests were available, almost half of the sample would be very likely (n = 54, 12.95%) or likely (n = 151, 36.21%) to use one if they felt they needed to. Upon receiving a positive self-test result, the majority of respondents would communicate it (88.49%), request facility-based post-test counseling (98.32%), self-isolate (97.60%), and warn their close contacts (96.64%).Conclusion Rapid SARS-CoV-2 antigen self-testing could be an acceptable screening tool in São Paulo. The population would be empowered by having access to a technology that would allow them to test, even if asymptomatic, when traveling, or going to work or school. If there is a surge in the incidence of cases,self-testing could be a good approach for mass case detection by Brazil’s already overstretched Unified Health System.

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

“…The high acceptability and willingness to obtain and use self-testing kits for SARS-CoV-2 dispensed from vending machines, particularly as a means of promoting precautionary and preventative measures to limit the spread of COVID-19, [9][10][11][12] seen in this study is similar to findings in Nigeria where the public perceived multiple benefits from self-testing kits, 19 Brazil where over half of the surveyed population would use self-testing kits if available, Cyprus and Greece at 79% of the population surveyed, Indonesia with over 60% of the population willing to use self-testing kits, and in the USA where 82.8% were motivated to order self-testing kits online. 22,23,52,53 Their acceptability will be helped by being conveniently located for citizens within UAE, limiting the need to wait in line to purchase the kits in pharmacies. In addition, providing other OTC medicines that can help with symptomatic relief of COVID-19 as well as offering guaranteed confidentiality.…”

“…Being employed, having completed education above primary school and living in a rural area enhanced the likelihood of using self-testing kits in Indonesia, with similar findings regarding education and employment in other countries. 22,23,52,53 Concerns regarding low literacy was also important regarding their use in Nigeria. 19 The introduction of OTC vending machines should also help ensure that self-test kits reach the population promptly, which will allow UAE to undertake increased testing with successive waves of the pandemic.…”

“…We used this methodology as we were unaware of any published questionnaires at the time including those used in Brazil, Indonesia and Nigeria. 19,[21][22][23] However, the findings from recently published studies will be used to place the general findings from this research in context apart from those specifically aimed at the availability and use of vending machines.…”

“…[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.…”

“…This builds on existing published studies documenting current preferences for RADTs among the population. 19,[21][22][23] The findings can be used to help guide future policy in this area in UAE and wider building on existing published studies.…”