Multi-site assessment of rapid, point-of-care antigen testing for the diagnosis of SARS-CoV-2 infection in a low-prevalence setting: A validation and implementation study

TLDR: In this paper, the authors evaluated the performance and implementation of rapid antigen-based SARS-CoV-2 testing in a setting with a low prevalence of COVID-19 infections, such as Australia.

Abstract: Background: In Australia, COVID-19 diagnosis relies on RT-PCR testing which is relatively costly and time-consuming To date, few studies have assessed the performance and implementation of rapid antigen-based SARS-CoV-2 testing in a setting with a low prevalence of COVID-19 infections, such as Australia Methods: This study recruited participants presenting for COVID-19 testing at three Melbourne metropolitan hospitals during a period of low COVID-19 prevalence The Abbott PanBioTM COVID-19 Ag point-of-care test was performed alongside RT-PCR In addition, participants with COVID-19 notified to the Victorian Government were invited to provide additional swabs to aid validation Implementation challenges were also documented Findings: The specificity of the Abbott PanBioTM COVID-19 Ag test was 9996% (95% CI 9973 - 100%) Sensitivity amongst participants with RT-PCR-confirmed infection was dependent upon the duration of symptoms reported, ranging from 773% (duration 1 to 33 days) to 100% in those within seven days of symptom onset A range of implementation challenges were identified which may inform future COVID-19 testing strategies in a low prevalence setting Interpretation: Given the high specificity, antigen-based tests may be most useful in rapidly triaging public health and hospital resources while expediting confirmatory RT-PCR testing Considering the limitations in test sensitivity and the potential for rapid transmission in susceptible populations, particularly in hospital settings, careful consideration is required for implementation of antigen testing in a low prevalence setting Funding: This work was funded by the Victorian Department of Health and Human Services The funder was not involved in data analysis or manuscript preparation