tetano
Editor, Senior Moderator
PLoS One
. 2024 Oct 4;19(10):e0311198.
doi: 10.1371/journal.pone.0311198. eCollection 2024. Cost-effectiveness of SARS-CoV-2 self-testing at routine gatherings to minimize community-level infections in lower-middle income countries: A mathematical modeling study
Megan A Hansen[SUP] 1 2 [/SUP], Alvin X Han[SUP] 3 [/SUP], Joshua M Chevalier[SUP] 1 2 [/SUP], Ethan Klock[SUP] 2 [/SUP], Hiromi Pandithakoralage[SUP] 2 [/SUP], Alexandra de Nooy[SUP] 1 [/SUP], Tom Ockhuisen[SUP] 1 [/SUP], Sarah J Girdwood[SUP] 4 5 [/SUP], Nkgomeleng A Lekodeba[SUP] 4 [/SUP], Shaukat Khan[SUP] 5 [/SUP], Helen E Jenkins[SUP] 6 [/SUP], Cheryl C Johnson[SUP] 7 [/SUP], Jilian A Sacks[SUP] 7 [/SUP], Colin A Russell[SUP] 3 [/SUP], Brooke E Nichols[SUP] 1 2 5 [/SUP]
Affiliations
Places of worship serve as a venue for both mass and routine gathering around the world, and therefore are associated with risk of large-scale SARS-CoV-2 transmission. However, such routine gatherings also offer an opportunity to distribute self-tests to members of the community to potentially help mitigate transmission and reduce broader community spread of SARS-CoV-2. Over the past four years, self-testing strategies have been an impactful tool for countries' response to the COVID-19 pandemic, especially early on to mitigate the spread when vaccination and treatment options were limited. We used an agent-based mathematical model to estimate the impact of various strategies of symptomatic and asymptomatic self-testing for a fixed percentage of weekly routine gatherings at places of worship on community transmission of SARS-CoV-2 in Brazil, Georgia, and Zambia. Testing strategies assessed included weekly and bi-weekly self-testing across varying levels of vaccine effectiveness, vaccine coverage, and reproductive numbers to simulate developing stages of the COVID-19 pandemic. Self-testing symptomatic people attending routine gatherings can cost-effectively reduce the spread of SARS-CoV-2 within places of worship and the community, resulting in incremental cost-effectiveness ratios of $69-$303 USD. This trend is especially true in contexts where population level attendance at such gatherings is high, demonstrating that a distribution approach is more impactful when a greater proportion of the population is reached. Asymptomatic self-testing of attendees at 100% of places of worship in a country results in the greatest percent of infections averted and is consistently cost-effective but remains costly. Budgetary needs for asymptomatic testing are expensive and likely unaffordable for lower-middle income countries (520-1550x greater than that of symptomatic testing alone), promoting that strategies to strengthen symptomatic testing should remain a higher priority.
. 2024 Oct 4;19(10):e0311198.
doi: 10.1371/journal.pone.0311198. eCollection 2024. Cost-effectiveness of SARS-CoV-2 self-testing at routine gatherings to minimize community-level infections in lower-middle income countries: A mathematical modeling study
Megan A Hansen[SUP] 1 2 [/SUP], Alvin X Han[SUP] 3 [/SUP], Joshua M Chevalier[SUP] 1 2 [/SUP], Ethan Klock[SUP] 2 [/SUP], Hiromi Pandithakoralage[SUP] 2 [/SUP], Alexandra de Nooy[SUP] 1 [/SUP], Tom Ockhuisen[SUP] 1 [/SUP], Sarah J Girdwood[SUP] 4 5 [/SUP], Nkgomeleng A Lekodeba[SUP] 4 [/SUP], Shaukat Khan[SUP] 5 [/SUP], Helen E Jenkins[SUP] 6 [/SUP], Cheryl C Johnson[SUP] 7 [/SUP], Jilian A Sacks[SUP] 7 [/SUP], Colin A Russell[SUP] 3 [/SUP], Brooke E Nichols[SUP] 1 2 5 [/SUP]
Affiliations
- PMID: 39365802
- PMCID: PMC11451991
- DOI: 10.1371/journal.pone.0311198
Places of worship serve as a venue for both mass and routine gathering around the world, and therefore are associated with risk of large-scale SARS-CoV-2 transmission. However, such routine gatherings also offer an opportunity to distribute self-tests to members of the community to potentially help mitigate transmission and reduce broader community spread of SARS-CoV-2. Over the past four years, self-testing strategies have been an impactful tool for countries' response to the COVID-19 pandemic, especially early on to mitigate the spread when vaccination and treatment options were limited. We used an agent-based mathematical model to estimate the impact of various strategies of symptomatic and asymptomatic self-testing for a fixed percentage of weekly routine gatherings at places of worship on community transmission of SARS-CoV-2 in Brazil, Georgia, and Zambia. Testing strategies assessed included weekly and bi-weekly self-testing across varying levels of vaccine effectiveness, vaccine coverage, and reproductive numbers to simulate developing stages of the COVID-19 pandemic. Self-testing symptomatic people attending routine gatherings can cost-effectively reduce the spread of SARS-CoV-2 within places of worship and the community, resulting in incremental cost-effectiveness ratios of $69-$303 USD. This trend is especially true in contexts where population level attendance at such gatherings is high, demonstrating that a distribution approach is more impactful when a greater proportion of the population is reached. Asymptomatic self-testing of attendees at 100% of places of worship in a country results in the greatest percent of infections averted and is consistently cost-effective but remains costly. Budgetary needs for asymptomatic testing are expensive and likely unaffordable for lower-middle income countries (520-1550x greater than that of symptomatic testing alone), promoting that strategies to strengthen symptomatic testing should remain a higher priority.