4_TypeofTest

4. Offer the right type of test

Serology/ Antibody tests

Consideration

Serology testing can increase confusion and frustration around test results and may discourage future testing.

Voices from the Field

“It was a serology study…it just took too long to get the results back and that eroded a lot of public trust.”
“More recently, it comes out that the benefit of antibody serological  testing is probably not where we want to see the benefit today, so we are now shifting gears”
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Antigen tests

Consideration

Antigen tests have been gaining interest.

Voices from the Field

“We are now shifting gears and thinking more about antigen screening approach as we go into the next few months…The challenge has been to find the right tool and the right lab partners to work with.”

Anterior nares vs. nasopharyngeal swab

Consideration

Anterior nares testing is favored over the NP swab by patients.

Voices from the Field

“I tell you what is happening especially for the old adults when we are doing the anterior approach, basically just the nasal swabbing versus nasopharyngeal, it just created a whole different level of acceptance of testing especially with the aging population.”

Rapid tests

Consideration

Rapid tests may be deployed through pop-up testing sites to reach geographically isolated populations.

Rapid tests can also be useful in justice systems, particularly in areas with very high volumes.

Rapid tests with low costs and high sensitivity and specificity that could be administered frequently would solve many problems faced by OSCTCs.

Voices from the Field

“…we've given Abbot ID now platforms to 15 or so facilities around the state [including an] FQHC that tests migrant workers.”
“The challenges we faced in our justice system is really the testing at entry, and the lack of a point-of-care option there. I would say a high sensitivity point-of-care option that issues a less than 4-hour turnaround on their lab test [would be preferable]”
“I'm hoping that we can get to a point where we are able to do some sort of rapid test on a daily basis, for our employees and our residents as well as the resident’s family so we can open up to visitors. Ideally, it would be nice to have someone’s family member come in, take a test and wait 10 or 15 minutes and get the results and be able to let them in to visit.”
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Self vs clinician administered

Consideration

Observed self-swabbing can minimize PPE needs.

Voices from the Field

“We are encouraging self-swabbing… some places are doing that now, so we are encouraging that as a way to conserve on PPE.”

Self-administered home tests

Consideration

Home test kits that do not require in-person staff would solve many current problems with OSCTCs.

Voices from the Field

“...a perfect world would be at home testing where you could do a tele-visit basically with the patient. They would have the kit in front of them and you would observe them doing the swab themselves, inserting the specimen and having them mail it back to the lab and having the results in, hopefully, 24 hours turnaround.”
“If we could come up with an at-home type collection where people could order it as they'd like, then I think that it would free up a lot of time and money that's spent within the system and we would better be able to get back to health care as we know it.”
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Pooled testing

Consideration

Pooled testing may be a good option for certain populations, in areas of low incidence.

More and more OSCTCs are considering pool testing, however, limited guidance is currently available.
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Voices from the Field

“If the school's staff does a baseline test before everybody goes back to school and their prevalence is pretty low, I think pooled testing is a really great option. It's more efficient and certainly more cost-effective. If the incidence and prevalence after that baseline test are really high, I think we'd probably recommend a more frequent testing cadence and sort of move away from the pool. So, we're exploring it as sort of a suite of options depending on what a site and the community prevalence really is.”
“It is a mathematical equation, right? Pooled testing is going to make a lot of sense if your positivity rates are lower.”
“There's all the logistics, like how easy is it to change on a given day your protocol from pooling 1 in 4 to 1 in 3 and so on and then how do you break those up? And how does your workflow go? So, I think we're trying to contribute to our understanding of that. We're not all in on pooling yet”
“We recently were approved for pooling…and …that will certainly help us expand capacity”.
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