JMIR Publications

ABSTRACT

Background:

Inadequate diagnostic and screening testing in the United States throughout the first several months of the COVID-19 pandemic led to both undetected cases transmitting disease in the community and an underestimation of cases. Though testing supply has increased, maintaining testing uptake remains a major public health priority in efforts to control community transmission in light of the availability of vaccinations and threats from variants.

Objective:

To identify patterns of preferences for SARS-CoV-2 screening and diagnostic testing prior to widespread vaccine availability and uptake.

Methods:

We conducted a discrete choice experiment (DCE) among participants in the national prospective Communities, Households, and SARS-CoV-2 Epidemiology (CHASING COVID) Cohort Study from July 30-September 8, 2020. The DCE elicited SARS-CoV-2 testing preferences for SARS-CoV-2 test type, specimen type, testing venue, and results turnaround time. We used latent class analysis to identify distinct patterns of preferences related to testing as measured by attribute relative importance and attribute level part-worth utilities, and conducted a simulation to predict testing uptake if additional testing scenarios were offered.

Results:

Of the 5,098 invited cohort participants, 4,793 participants (94%) completed the DCE from July 30 through September 8, 2020. Five distinct patterns of SARS-CoV-2 testing emerged. “Non-invasive home testers” (N=920, 19.2% of participants) were most influenced by specimen type and favored less invasive specimen collection methods, with saliva most preferred; this group was the least likely to opt-out of testing. “Fast-track testers” (N=1,235, 25.8%) were most influenced by result turnaround time and favored immediate and same day turnaround time. Among “Dual testers” (N=889, 18.5%) test type was the most important attribute and they preferred both antibody and viral tests. “Non-invasive dual testers” (N=1,578, 32.9%) were most strongly influenced by specimen type and test type, preferring saliva and cheek swab specimens and both antibody and viral tests. Among “Hesitant home testers” (N=171, 3.6%) venue was the most important attribute; notably, this group was the most likely to opt-out of testing. Simulation models predicted that testing uptake would increase from 81.6% (with a status quo scenario of polymerase chain reaction by nasal swab in a provider’s office and a turnaround time of several days) to 98.1% by offering additional scenarios using less invasive specimens, both viral and antibody tests from a single specimen, faster turnaround time, and at-home testing.

Conclusions:

We identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options would likely increase testing uptake in line with public health goals. Additional studies may be warranted to understand if preferences for testing have changed since the availability and widespread uptake of vaccines.