Ignite Creation Date:
2024-05-06 @ 4:10 PM
Last Modification Date:
2024-10-26 @ 2:05 PM
Study NCT ID:
NCT04896710
Status:
UNKNOWN
Last Update Posted:
2021-06-02
First Post:
2021-05-05
Brief Title:
COVID-19 Rapid Testing for Self-Administration Among an Asymptomatic Sample
Sponsor:
University of British Columbia
Organization:
University of British Columbia
Study Overview
Official Title:
Rapid Testing for Self-Administration Among an Asymptomatic Sample
Status:
UNKNOWN
Status Verified Date:
2021-05
Last Known Status:
ENROLLING_BY_INVITATION
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Point-of-care testing can provide an additional layer of protection to reduce transmission of COVID-19 safely and effectively in the population and if such tests can be self-administered barriers to access may be reduced The investigators will conduct a study among those self-identifying as asymptomatic for COVID-19 to evaluate the reliability and feasibility of self-administration of a point-of-care nasal swab test determine the sensitivity and specificity of the point-of-care nasal swab test relative to reverse transciptase polymerase chain reaction RT-PCR testing and gather quantitative and qualitative data on the acceptability and self efficacy of self-administration
Detailed Description:
In Canada the age distribution of COVID-19 has demonstrated that young adults are susceptible to infection As of mid-December about 19 of cases have occurred in the 20-29 year age group and about 3 of those hospitalized were 20-29 years of age In BC in week 50 the incidence was highest in adults 20-29 years 127 cases per 100000 population which is four times higher than what was observed in week 38 30 cases per 100000 population These statistics highlight the need to disrupt transmission in this group
Congregate living settings have been established as high-risk environments for community transmission of SARS-CoV-2 Moreover there is a need to ensure the workforce feels safe in returning back to work across post-secondary institutions While the COVID-19 vaccine rollout has commenced in BC according to experts in the field the pandemic is likely to persist for some time For people living in congregate housing and for post-secondary institutions to open safely COVID-19 mitigation strategies are as important as ever There is no current public health strategy used for systematic COVID-19 screening for those living in congregate housing Individuals are expected to monitor themselves daily for symptoms and use multiple layers of protection which include physical distancing mask wearing and hand washing
However this strategy is not very effective because these measures are relatively insensitive and thus unlikely to identify all individuals with SARS-CoV2 especially those who are minimally symptomatic or believe they are asymptomatic Indeed public health experts have poignantly stated that transmission of the virus through asymptomatic individuals is the Achilles Heel of Current Strategies to Control COVID-19 1 This is because unlike SARS-CoV-1 the cause of the original SARS epidemic in 2003 SARS-CoV-2 sheds at high concentrations from the nasal cavity even in asymptomatic individuals who may harbour the virus but have yet to demonstrate any symptoms during the prodromal phase of the disease 2 Even with masking and social distancing such individuals could be at a high risk of spreading the virus in congregate housing and in enclosed spaces eg classrooms One approach to reducing the risk of SARS-CoV-2 transmission amongst those living in congregate housing and working in enclosed spaces with large numbers of people eg classrooms is to screen for those who are likely to harbour the virus even though they may have no or minimal symptoms However the current diagnostic approach which uses real-time reverse transcriptase polymerase chain reaction RT-PCR to detect the presence of viral RNA from nasopharyngeal swabs cannot be easily deployed for this purpose
The RT-PCR test is expensive 100test time-consuming with turnaround times of 1-2 days and requires trained healthcare personnel to administer the test A potential solution to this conundrum is to use a point-of-care test which can be deployed at either work or a congregate housing site and whose results will be available within one hour of testing However for these assays or platforms to be viable they will need to be used as screening rather than diagnostic tests see below for more detailed discussion on this topic and be relatively simple to use so ideally they can be self-administered and inexpensive
What is the difference between diagnostic and screening tests
Diagnostic testing for SARS-CoV-2 is intended to identify occurrence at the individual level and is performed when there is a reason to suspect that an individual may be infected such as having symptoms or suspected recent exposure or to determine resolution of infection Examples of diagnostic testing include testing symptomatic individuals who present to their healthcare provider testing individuals through contact tracing efforts testing individuals who indicate that they were exposed to someone with a confirmed or suspected case of COVID-19 and testing individuals present at an event where an attendee was later confirmed to have COVID-19 The US Food and Drug Administrations FDA FAQs on Testing for SARS-CoV-2 also address diagnostic testing for SARSCoV-2
Screening tests for SARS-CoV-2 on the other hand are intended to identify occurrence at the individual level even if there is no reason to suspect infection-eg there is no known exposure This includes but is not limited to screening of asymptomatic individuals without known exposure with the intent of making decisions based on the test results Screening tests are intended to identify infected individuals without or prior to development of symptoms who may be contagious so that measures can be taken to prevent further transmission Examples of screening include testing plans developed by a workplace to test its employees and testing plans developed by a school to test its students faculty and staff In both examples the intent is to use the screening testing results to determine who may continue to participate in activities and the protective measures that must be taken including self-isolation FDAs FAQs on Testing for SARSCoV- 2 also address screening testing for SARS-CoV-2
In summary a screening COVID-19 test is one that is specific for SARS-CoV-2 but has a lower sensitivity ie ability to detect the virus than that of a diagnostic test the gold standard Thus even those who have a negative screening test should be considered potentially infectious and must adhere to social distancing masking rules and all other public health ordersguidelines Those who are tested positive on the screening test must be assumed to have COVID-19 until proven otherwise by a confirmatory RT-PCR test This approach of using point-of-care screening tests was recently advocated by The New England Journal of Medicine 3
The investigators have conducted a feasibility pilot from February 9-April 23 2021 at Orchard Commons University of British Columbia The investigators tested BD Veritor nasal swab rapid antigen test since it was already approved by Health Canada and supported by the Vancouver Coastal Health Medical Health Officer The investigators examined the feasibility of participants to self-collect nasal swabs and considered the ability to complete the rapid antigen test The BD Veritor system entails much accuracy of putting the mucosal cells into the small dropper This system also has an analytic reader The investigators believe this system will be useful when it can be administered by a trained person because of the dropper and the need for an analytic reader Based on a small survey n184 the team concluded that following
Nasal swabs are acceptable 99 of participants rated nasal swabbing as acceptablevery acceptable
Rapid antigen tests need to take no longer than 15 minutes In order to move to self administration the team believes there should be no analytic reader and that the participant should be able to tell with a visual examination if the rapid antigen test was positive much like a pregnancy test The Roche SD biosensor test was chosen for this study since it is a low complexity test that can likely be used by many of the general public
Primary Goal The primary goal of this study is to determine and test the feasibility reliability and sensitivityspecificity of COVID-19 self-administered screening amongst those who are asymptomatic and living andor working at UBC The investigators will evaluate whether rapid antigen testing can identify virus transmission chains early through the identification of pre-symptomatic and asymptomatic cases and direct students and staff with positive test results to follow appropriate public health precautions - all of which are proven to minimize viral spread
Congregate living settings have been established as high-risk environments for community transmission of SARS-CoV-2 Moreover there is a need to ensure the workforce feels safe in returning back to work across post-secondary institutions While the COVID-19 vaccine rollout has commenced in BC according to experts in the field the pandemic is likely to persist for some time For people living in congregate housing and for post-secondary institutions to open safely COVID-19 mitigation strategies are as important as ever There is no current public health strategy used for systematic COVID-19 screening for those living in congregate housing Individuals are expected to monitor themselves daily for symptoms and use multiple layers of protection which include physical distancing mask wearing and hand washing
However this strategy is not very effective because these measures are relatively insensitive and thus unlikely to identify all individuals with SARS-CoV2 especially those who are minimally symptomatic or believe they are asymptomatic Indeed public health experts have poignantly stated that transmission of the virus through asymptomatic individuals is the Achilles Heel of Current Strategies to Control COVID-19 1 This is because unlike SARS-CoV-1 the cause of the original SARS epidemic in 2003 SARS-CoV-2 sheds at high concentrations from the nasal cavity even in asymptomatic individuals who may harbour the virus but have yet to demonstrate any symptoms during the prodromal phase of the disease 2 Even with masking and social distancing such individuals could be at a high risk of spreading the virus in congregate housing and in enclosed spaces eg classrooms One approach to reducing the risk of SARS-CoV-2 transmission amongst those living in congregate housing and working in enclosed spaces with large numbers of people eg classrooms is to screen for those who are likely to harbour the virus even though they may have no or minimal symptoms However the current diagnostic approach which uses real-time reverse transcriptase polymerase chain reaction RT-PCR to detect the presence of viral RNA from nasopharyngeal swabs cannot be easily deployed for this purpose
The RT-PCR test is expensive 100test time-consuming with turnaround times of 1-2 days and requires trained healthcare personnel to administer the test A potential solution to this conundrum is to use a point-of-care test which can be deployed at either work or a congregate housing site and whose results will be available within one hour of testing However for these assays or platforms to be viable they will need to be used as screening rather than diagnostic tests see below for more detailed discussion on this topic and be relatively simple to use so ideally they can be self-administered and inexpensive
What is the difference between diagnostic and screening tests
Diagnostic testing for SARS-CoV-2 is intended to identify occurrence at the individual level and is performed when there is a reason to suspect that an individual may be infected such as having symptoms or suspected recent exposure or to determine resolution of infection Examples of diagnostic testing include testing symptomatic individuals who present to their healthcare provider testing individuals through contact tracing efforts testing individuals who indicate that they were exposed to someone with a confirmed or suspected case of COVID-19 and testing individuals present at an event where an attendee was later confirmed to have COVID-19 The US Food and Drug Administrations FDA FAQs on Testing for SARS-CoV-2 also address diagnostic testing for SARSCoV-2
Screening tests for SARS-CoV-2 on the other hand are intended to identify occurrence at the individual level even if there is no reason to suspect infection-eg there is no known exposure This includes but is not limited to screening of asymptomatic individuals without known exposure with the intent of making decisions based on the test results Screening tests are intended to identify infected individuals without or prior to development of symptoms who may be contagious so that measures can be taken to prevent further transmission Examples of screening include testing plans developed by a workplace to test its employees and testing plans developed by a school to test its students faculty and staff In both examples the intent is to use the screening testing results to determine who may continue to participate in activities and the protective measures that must be taken including self-isolation FDAs FAQs on Testing for SARSCoV- 2 also address screening testing for SARS-CoV-2
In summary a screening COVID-19 test is one that is specific for SARS-CoV-2 but has a lower sensitivity ie ability to detect the virus than that of a diagnostic test the gold standard Thus even those who have a negative screening test should be considered potentially infectious and must adhere to social distancing masking rules and all other public health ordersguidelines Those who are tested positive on the screening test must be assumed to have COVID-19 until proven otherwise by a confirmatory RT-PCR test This approach of using point-of-care screening tests was recently advocated by The New England Journal of Medicine 3
The investigators have conducted a feasibility pilot from February 9-April 23 2021 at Orchard Commons University of British Columbia The investigators tested BD Veritor nasal swab rapid antigen test since it was already approved by Health Canada and supported by the Vancouver Coastal Health Medical Health Officer The investigators examined the feasibility of participants to self-collect nasal swabs and considered the ability to complete the rapid antigen test The BD Veritor system entails much accuracy of putting the mucosal cells into the small dropper This system also has an analytic reader The investigators believe this system will be useful when it can be administered by a trained person because of the dropper and the need for an analytic reader Based on a small survey n184 the team concluded that following
Nasal swabs are acceptable 99 of participants rated nasal swabbing as acceptablevery acceptable
Rapid antigen tests need to take no longer than 15 minutes In order to move to self administration the team believes there should be no analytic reader and that the participant should be able to tell with a visual examination if the rapid antigen test was positive much like a pregnancy test The Roche SD biosensor test was chosen for this study since it is a low complexity test that can likely be used by many of the general public
Primary Goal The primary goal of this study is to determine and test the feasibility reliability and sensitivityspecificity of COVID-19 self-administered screening amongst those who are asymptomatic and living andor working at UBC The investigators will evaluate whether rapid antigen testing can identify virus transmission chains early through the identification of pre-symptomatic and asymptomatic cases and direct students and staff with positive test results to follow appropriate public health precautions - all of which are proven to minimize viral spread
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None