Evaluating social and spatial inequalities of large scale rapid lateral flow SARS-CoV-2 antigen testing in COVID-19 management: An observational study of Liverpool, UK (November 2020 to January 2021)



Green, Mark ORCID: 0000-0002-0942-6628, García-Fiñana, Marta, Barr, Ben ORCID: 0000-0002-4208-9475, Burnside, Girvan ORCID: 0000-0001-7398-1346, Cheyne, Christopher, Hughes, David ORCID: 0000-0002-1287-9994, Ashton, Matthew, Sheard, Sally, Geddes, Andrew, Rankin, John
et al (show 1 more authors) (2021) Evaluating social and spatial inequalities of large scale rapid lateral flow SARS-CoV-2 antigen testing in COVID-19 management: An observational study of Liverpool, UK (November 2020 to January 2021). [Preprint]

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Abstract

<h4>Objective</h4> To explore social and spatial inequalities in uptake and case-detection of rapid lateral flow SARS-CoV-2 antigen tests (LFTs) offered to people without symptoms of COVID-19. <h4>Design</h4> Observational study. <h4>Setting</h4> Liverpool, UK. <h4>Participants</h4> 496 784 residents. <h4>Intervention</h4> Free LFTs to all people living and working in Liverpool (6 th November 2020 to 31 st January 2021). <h4>Main outcome measures</h4> Residents who received a LFT, residents who had multiple LFTs, and positive test results. <h4>Results</h4> 214 525 residents (43%) received a LFT identifying 5557 individuals as positive cases of COVID-19 (1.3%) between 6 th November 2020 and 31 st January 2021. 89 047 residents had more than one test (18%). Uptake was highest in November when there was military assistance. High uptake was observed again in the week preceding Christmas and was sustained into a national lockdown. Overall uptake and repeat testing were lower among males (e.g. 40% uptake over the whole period), Black Asian and other Minority Ethnic groups (e.g. 27% uptake for ‘Mixed’ ethnicity) and in the most deprived areas (e.g. 32% uptake in most deprived areas). These population groups were also more likely to have received positive tests for COVID-19. Spatial regression models demonstrated that uptake and repeat testing were lower in areas of higher deprivation, areas located further from test sites and areas containing populations less confident in the using Internet technologies. Positive tests were spatially clustered in deprived areas. <h4>Conclusions</h4> Large-scale voluntary asymptomatic community testing saw social, ethnic, and spatial inequalities in an ‘inverse care’ pattern, but with an added digital exclusion factor. COVID-19 testing and support to isolate need to be more accessible to the vulnerable communities most impacted by the pandemic, including non-digital means of access. <h4>What is already known on this topic</h4> Testing asymptomatic individuals with rapid lateral flow SARS-CoV-2 antigen devices detects the most infectious individuals who otherwise would have been unaware they were likely to infect others. Liverpool (UK) conducted the world’s first whole population, open-access, voluntary asymptomatic testing programme for COVID-19 management. The impacts of such testing on inequalities are unknown. <h4>What this study adds</h4> Testing uptake was lower, and test positivity was higher, among deprived populations, Black Asian and other Minority Ethnic groups and areas classified as having low Internet use. Population-wide asymptomatic testing programmes need to account for social, spatial, and digital access issues in their design, communication and delivery to minimise inequalities in outcomes.

Item Type: Preprint
Additional Information: Source info: THELANCET-D-21-01107
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Faculty of Science and Engineering > School of Environmental Sciences
Depositing User: Symplectic Admin
Date Deposited: 26 Mar 2021 10:29
Last Modified: 18 Jan 2023 22:54
DOI: 10.1101/2021.02.10.21251256
Open Access URL: https://www.medrxiv.org/content/10.1101/2021.02.10...
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3118171