Acceptability, Feasibility, and Uptake of COVID-19 Antigen Rapid Diagnostic Self-Testing at the Community Level in Tanzania

Abstract

The rapid diagnosis of coronavirus disease 2019 (COVID-19) is critical for comprehensive public health response strategies, and self-testing with antigen rapid diagnostic tests (Ag-RDTs) presents opportunities to test in hard-to-reach communities. Therefore, we evaluated the acceptability, feasibility, and uptake of Ag-RDT self-testing at the community level in Tanzania. From June to October 2022, symptomatic individuals or those with recent contact with a known or suspected COVID-19 patient were offered assisted testing and self-testing within mining communities and at transport hubs. This study included a cross-sectional survey before and after implementation. Participants were assessed for their acceptability and uptake of the nasal Ag-RDT self-test and their preference for nasal Ag-RDT self-testing. The survey data were collected in Open Data Kit, whereas the Ag-RDT results in the community were recorded by using the COVISUSPECT Mobile Application. Data analysis was performed by using STATA and R Statistical Software. A total of 538 individuals were screened, and 454 (84.4%) consented to be tested. The preference for self-testing was relatively low (33%), and the majority of participants (67%) opted to be assisted by a healthcare professional. Of the participants who opted for testing, 149 (32.8%) were able to self-test. Generally, there was no major difference in the various assessed parameters between the baseline and end-line surveys. The results from fitting multiple logistic regression indicated that after controlling for age, participants living in Dodoma were significantly less likely to opt for self-testing (odds ratio = 0.54; P-value = 0.023) compared with those living in Dar es Salaam. There was no significant difference in self-testing between participants living in Mara and those living in Dar es Salaam (odds ratio = 0.7; P-value = 0.179). After controlling for region, older (≥40 years) participants were significantly less likely to self-test compared with participants aged 18 to <40 years (odds ratio = 0.47; P-value = 0.002). The intervention was well-accepted in all areas in which Ag-RDTs were deployed. Our findings can therefore support the Ministry of Health by increasing accessibility to severe acute respiratory syndrome coronavirus 2 testing in the hard-to-reach communities in response to the next COVID-19 wave.