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

Citation

Stephen Muhi, Nick Tayler, Tuyet Hoang, Susan A. Ballard, Maryza Graham, Amanda Rojek, Jason C. Kwong, Jason A. Trubiano, Olivia Smibert, George Drewett, Fiona James, Emma Gardiner, Socheata Chea, Nicole Isles, Michelle Sait, Shivani Pasricha, George Taiaroa, Julie McAuley, Eloise Williams, Katherine B. Gibney, Timothy P. Stinear, Katherine Bond, Sharon R Lewin, Mark Putland, Benjamin P. Howden, Deborah A. Williamson

Lancet Regional Health Western Pacific, volume 9, 100115, 1 April 2021. DOI: https://doi.org/10.1016/j.lanwpc.2021.100115

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┬áCOVID-19 Ag test was 99.96% (95% CI 99.73 – 100%). Sensitivity amongst participants with RT-PCR-confirmed infection was dependent upon the duration of symptoms reported, ranging from 77.3% (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.