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Influenza Other Respir Viruses
. 2021 May 3.
doi: 10.1111/irv.12859. Online ahead of print.
A remote household-based approach to influenza self-testing and antiviral treatment
Jessica Heimonen 1 , Denise J McCulloch 1 , Jessica O'Hanlon 1 , Ashley E Kim 1 , Anne Emanuels 1 , Naomi Wilcox 1 , Elisabeth Brandstetter 1 , Mark Stewart 2 , David McCune 2 , Scott Fry 3 , Sean Parsons 3 , James P Hughes 4 , Michael L Jackson 5 , Timothy M Uyeki 6 , Michael Boeckh 7 , Lea M Starita 8 9 , Trevor Bedford 7 , Janet A Englund 10 , Helen Y Chu 1
Affiliations
- PMID: 33939275
- DOI: 10.1111/irv.12859
Abstract
Background: Households represent important settings for transmission of influenza and other respiratory viruses. Current influenza diagnosis and treatment relies upon patient visits to healthcare facilities, which may lead to under-diagnosis and treatment delays. This study aimed to assess the feasibility of an at-home approach to influenza diagnosis and treatment via home testing, telehealth care, and rapid antiviral home delivery.
Methods: We conducted a pilot interventional study of remote influenza diagnosis and treatment in Seattle-area households with children during the 2019-2020 influenza season using pre-positioned nasal swabs and home influenza tests. Home monitoring for respiratory symptoms occurred weekly; if symptoms were reported within 48 hours of onset, participants collected mid-nasal swabs and used a rapid home-based influenza immunoassay. An additional home-collected swab was returned to a laboratory for confirmatory influenza RT-PCR testing. Baloxavir antiviral treatment was prescribed and delivered to symptomatic and age-eligible participants, following a telehealth encounter.
Results: 124 households comprising 481 individuals self-monitored for respiratory symptoms, with 58 home tests administered. 12 home tests were positive for influenza, of which eight were true positives confirmed by RT-PCR. The sensitivity and specificity of the home influenza test were 72.7% and 96.2%, respectively. There were eight home deliveries of baloxavir, with 7 (87.5%) occurring within 3 hours of prescription and all within 48 hours of symptom onset.
Conclusions: We demonstrate the feasibility of self-testing combined with rapid home delivery of influenza antiviral treatment. This approach may be an important control strategy for influenza epidemics and pandemics.
Keywords: Ellume; baloxavir; households; influenza; testing; treatment.