Self-sampling versus health care professional-guided swab collection for SARS-CoV-2 testing

Silvia Würstle, Christoph D Spinner, Florian Voit, Dieter Hoffmann, Svenja Hering, Simon Weidlich, Jochen Schneider, Alexander Zink, Matthias Treiber, Roman Iakoubov, Roland M Schmid, Ulrike Protzer, Johanna Erber, Silvia Würstle, Christoph D Spinner, Florian Voit, Dieter Hoffmann, Svenja Hering, Simon Weidlich, Jochen Schneider, Alexander Zink, Matthias Treiber, Roman Iakoubov, Roland M Schmid, Ulrike Protzer, Johanna Erber

Abstract

Purpose: To evaluate the diagnostic reliability and practicability of self-collected oropharyngeal swab samples for the detection of SARS-CoV-2 infection as self-sampling could enable broader testing availability and reduce both personal protective equipment and potential exposure.

Methods: Hospitalized SARS-CoV-2-infected patients were asked to collect two oropharyngeal swabs (SC-OPS1/2), and an additional oropharyngeal swab was collected by a health care professional (HCP-OPS). SARS-CoV-2 PCR testing for samples from 58 participants was performed, with a 48-h delay in half of the self-collected samples (SC-OPS2). The sensitivity, probability of concordance, and interrater reliability were calculated. Univariate and multivariate analyses were performed to assess predictive factors. Practicability was evaluated through a questionnaire.

Results: The test sensitivity for HCP-OPS, SC-OPS1, and SC-OPS2 was 88%, 78%, and 77%, respectively. Combining both SC-OPS results increased the estimated sensitivity to 88%. The concordance probability between HCP-OPS and SC-OPS1 was 77.6% and 82.5% between SC-OPS1 and SC-OPS2, respectively. Of the participants, 69% affirmed performing future self-sampling at home, and 34% preferred self-sampling over HCP-guided testing. Participants with both positive HCP-OPS1 and SC-OPS1 indicating no challenges during self-sampling had more differences in viral load levels between HCP-OPS1 and SC-OPS1 than those who indicated challenges. Increasing disease duration and the presence of anti-SARS-CoV-2-IgG correlated with negative test results in self-collected samples of previously confirmed SARS-CoV-2 positive individuals.

Conclusion: Oropharyngeal self-sampling is an applicable testing approach for SARS-CoV-2 diagnostics. Self-sampling tends to be more effective in early versus late infection and symptom onset, and the collection of two distinct samples is recommended to maintain high test sensitivity.

Keywords: COVID-19; Oropharyngeal; SARS-CoV-2; Self-sampling; Swab.

Conflict of interest statement

All authors aside of Christoph D. Spinner and Simon Weidlich declare that they have no conflicts of interest. Christoph Spinner reports grants, personal fees, non-financial support and other from AbbVie, grants, personal fees, non-financial support and other from Apeiron, personal fees from Formycon, grants, personal fees, non-financial support and other from Gilead Sciences, grants, personal fees and other from Eli Lilly, grants, personal fees, non-financial support and other from Janssen-Cilag, grants, personal fees, non-financial support and other from GSK/ViiV Healthcare, grants, personal fees, non-financial support and other from MSD, outside the submitted work. Simon Weidlich reports personal fees and non-financial support from Gilead Sciences and Janssen-Cilag outside the submitted work.

© 2021. The Author(s).

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