Self-testing for SARS-CoV-2 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 SARS-CoV-2 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 SARS-CoV-2 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.

People’s willingness to use COVID-19 self-testing in Nigeria: a cross-sectional survey

“…Our survey showed a high acceptability towards COVID-19 self-testing, and a high degree of willingness to comply with hygiene and infection-control measures on receiving a positive self-test result. Agreement with the use of COVID-19 self-tests was higher in our survey than in surveys conducted with the same methodological approach in Indonesia and Brazil 21 22. This could in part be due to differences in access to conventional COVID-19 testing between the countries.…”

“…This could in part be due to differences in access to conventional COVID-19 testing between the countries. In Nigeria, 79.48% of respondents reported having never had difficulty accessing a COVID-19 test, compared with 94.76% in Indonesia and 74.35% in Brazil 21 22. Acceptability of self-testing in Nigeria was also higher than in an online survey conducted in Greece and Cyprus, where 79.0% of respondents from the general public reported willingness to self-test 17.…”

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

“…Thirteen studies reported an overall high acceptability and willingness to use COVIDST. COVIDST acceptability was high (91%-98.7%) in two studies, with higher acceptability in females (73.91%) versus males (60.09%) reported in another study [50][51][52]. Acceptability was lower (39.48%-51.1%) for daily self-testing [38, 40, [40].…”

Cost of SARS-CoV-2 self-test distribution programmes by different modalities: a micro-costing study in five countries (Brazil, Georgia, Malaysia, Ethiopia and the Philippines)

“…These pilot implementation studies were designed to provide COVID-19 self-tests to employees, their household members and clinic clients in a variety of different settings—ranging from healthcare settings, to workplaces, to schools (table 1). The goal of the pilot studies was to assess and continuously improve COVID-19 self-testing distribution strategies, the feasibility of the implementation and participants’ acceptability—as an appropriate intervention to increase uptake of testing and detection of cases of COVID-19 in the target populations 7. Additionally, these pilot studies aimed to calculate the cost of providing COVID-19 self-testing via several distribution modalities in different countries.…”

“…Distribution of self-test kits would allow for the scale-up of COVID-19 testing in limited-resource settings, where regular screening through provider-initiated and/or laboratory-based platforms, such as PCR tests, is constrained. While there are some studies on the use of Ag-RDT self-tests in schools, workplaces and within the broader community, these studies focus primarily on the usability or accuracy in comparison with provider-offered testing 4–7. There is limited research on the relative programmatic costs for the implementation and distribution of COVID-19 self-tests through different modalities, especially in low-resource settings or among communities with restricted access to conventional COVID-19 testing, where self-testing may be of most benefit 8…”