Bonnet, Gabrielle; Vassall, Anna; Jit, Mark; (2023) Is there a role for RDTs as we live with COVID-19? An assessment of different strategies. BMJ global health, 8 (1). e010690-e010690. ISSN 2059-7908 DOI: https://doi.org/10.1136/bmjgh-2022-010690
Permanent Identifier
Use this Digital Object Identifier when citing or linking to this resource.
Abstract
INTRODUCTION: By 2022, high levels of past COVID-19 infections, combined with substantial levels of vaccination and the development of Omicron, have shifted country strategies towards burden reduction policies. SARS-CoV-2 rapid antigen tests (rapid diagnostic tests (RDTs)) could contribute to these policies by helping rapidly detect, isolate and/or treat infections in different settings. However, the evidence to inform RDT policy choices in low and middle-income countries (LMICs) is limited. METHOD: We provide an overview of the potential impact of several RDT use cases (surveillance; testing, tracing and isolation without and with surveillance; hospital-based screening to reduce nosocomial COVID-19; and testing to enable earlier/expanded treatment) for a range of country settings. We use conceptual models and literature review to identify which use cases are likely to bring benefits and how these may change with outbreak characteristics. Impacts are measured through multiple outcomes related to gaining time, reducing the burden on the health system and reducing deaths. RESULTS: In an optimal scenario in terms of resources and capacity and with baseline parameters, we find marginal time gains of 4 days or more through surveillance and testing tracing and isolation with surveillance, a reduction in peak intensive care unit (ICU) or ICU admissions by 5% or more (hospital-based screening; testing, tracing and isolation) and reductions in COVID-19 deaths by over 6% (hospital-based screening; test and treat). Time gains may be used to strengthen ICU capacity and/or boost vulnerable individuals, though only a small minority of at-risk individuals could be reached in the time available. The impact of RDTs declines with lower country resources and capacity, more transmissible or immune-escaping variants and reduced test sensitivity. CONCLUSION: RDTs alone are unlikely to dramatically reduce the burden of COVID-19 in LMICs, though they may have an important role alongside other interventions such as vaccination, therapeutic drugs, improved healthcare capacity and non-pharmaceutical measures.
Item Type | Article |
---|---|
Faculty and Department |
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research Faculty of Public Health and Policy > Dept of Global Health and Development Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology & Dynamics (2023-) |
Research Centre |
Covid-19 Research Centre for the Mathematical Modelling of Infectious Diseases |
PubMed ID | 36657797 |
Elements ID | 198148 |
Official URL | http://dx.doi.org/10.1136/bmjgh-2022-010690 |
Download
Filename: Bonnett_etal_2023_Is-there-a-role-for.pdf
Licence: Creative Commons: Attribution 4.0
Download