Diagnostic Testing Preferences Can Help Inform Future Public Health Response Efforts: Global Insights from an International Survey
Leah Salzano, Nithya Narayanan, Emily R. Tobik, Sumaira Akbarzada, Yanjun Wu, Sarah Megiel, Brittany Choate, Anne L. Wyllie
Abstract
Public perception regarding diagnostic sample types as well as personal experiences can influence willingness to test. As such, public preferences for specific sample type(s) should be used to inform diagnostic and surveillance testing programs to improve public health response efforts. To understand where preferences lie, we conducted an international survey regarding the sample types used for SARS-CoV-2 tests. A Qualtrics survey regarding SARS-CoV-2 testing preferences was distributed via social media and email. The survey collected preferences regarding sample methods and key demographic data. Python was used to analyze survey responses. From March 30th to June 15th, 2022, 2,094 responses were collected from 125 countries. Participants were 55% female and predominantly aged 25–34 years (27%). Education and employment were skewed: 51% had graduate degrees, 26% had bachelor’s degrees, 27% were scientists/researchers, and 29% were healthcare workers.
Introduction
Strategies for diagnostic testing rapidly evolved during the coronavirus disease 2019 (COVID-19) pandemic in response to unprecedented worldwide demand. These additional tools are now available to help support seasonal respiratory virus epidemics or future outbreaks of emerging pathogens. Testing during outbreaks remains the most reliable tool for directing efforts and resources; it is the identification of infected individuals that can help to mitigate transmission [1]. The variety of test modalities available (including polymerase chain reaction [PCR], loop-mediated isothermal amplification [LAMP], antigen, and serology tests; Table A in S1 Appendix) can be used to support outbreak-response efforts in three key ways: 1). diagnostic testing for symptomatic individuals, 2). diagnostic testing for asymptomatic individuals, and 3). large-scale screening for ongoing disease surveillance.
Methods
The study protocol and survey design were reviewed by the Institutional Review Board at Yale School of Medicine (Protocol #2000031966) and was deemed exempt from additional oversight (“Any disclosure of the human subjects’ responses outside the research would not reasonably place the subjects at risk of criminal or civil liability or be damaging to the subjects’ financial standing, employability, educational advancement, or reputation”). Demographic data and survey responses were only collected after the study participant had been presented with an information sheet outlining the risks and benefits of the study. Informed consent was provided by completing the survey.
Results
From March 30th to June 15th, 2022, a total of 2,094 responses were collected from 7 regions: Africa (22%), Asia (8%), Europe (22%), Latin America/The Caribbean (9%), North America (27%), the Middle East (7%), and Oceania (6%) (Table 1; Table D in S1 Appendix). Participants were 55% female, 44% male, and 1% non-binary and ranged in age from 18–24 (13%), 25–34 (27%), 35–44 (23%), 45–54 (16%), 55–64 (14%), and 65+ (7%) years. The survey had a completion rate of 68% (Table 2). The number of responses received for each question are detailed in Table E in S1 Appendix. Respondent education level was skewed, with 51% holding a graduate degree, 26% holding a bachelor’s degree, and 10% with some college education. Additionally, 27% were scientists/researchers and 29% were healthcare workers.
Discussion
Individuals previously infected with or vaccinated against SARS-CoV-2 will continue to be at risk of reinfection [6] as immunity wanes and/or as new variants continue to emerge. Moreover, global health organizations are focused on proactively planning for future pandemics and warn of the continued risk of outbreaks and emerging pathogens for which outbreak responses will be needed [7, 8]. Early detection can help mitigate the spread of infectious diseases throughout communities and improve surveillance.
In order to help global experts, policymakers, and test developers create future public health measures that have public buy-in, this study sought to better understand the global community’s preferences in regards to diagnostic testing, screening and surveillance, across regions, age groups, occupations, and more. Importantly, knowledge gathered on testing preferences from experiences during the COVID-19 pandemic can help better inform broader public health responses in the future.
Citation: Salzano L, Narayanan N, Tobik ER, Akbarzada S, Wu Y, Megiel S, et al. (2024) Diagnostic testing preferences can help inform future public health response efforts: Global insights from an international survey. PLOS Glob Public Health 4(7): e0003547. https://doi.org/10.1371/journal.pgph.0003547
Editor: Nei-yuan (Marvin) Hsiao, University of Cape Town Faculty of Health Sciences, SOUTH AFRICA
Received: December 22, 2023; Accepted: July 8, 2024; Published: July 30, 2024
Copyright: © 2024 Salzano et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The data that support the findings of this study are available in the manuscript and in the Supporting Information.
Funding: The study was supported by SalivaDirect, Inc (ALW). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The study protocol was designed by the Yale researchers. The decision to publish was made by the Yale researchers; all authors agree with the decision to publish and with the results of the study.
Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: ALW has received consulting and/or advisory board fees from Pfizer, Merck, Diasorin, PPS Health, Co-Diagnostics, and Global Diagnostic Systems for work unrelated to this project, and is Principal Investigator on research grants from Pfizer, Merck, NIH RADx UP and SalivaDirect, Inc. to Yale University and from NIH RADx, Balvi.io and Shield T3 to SalivaDirect, Inc. All other co-authors declare no potential conflict of interest.
