Design and implementation of a national program to monitor the prevalence of SARS-CoV-2 IgG antibodies in England using self-testing: the REACT-2 study

Journal article

Data System. The UK Department of Health and Social Care funded the REal-time Assessment of Community Transmission-2 (REACT-2) study to estimate community prevalence of SARS-CoV-2 IgG (immunoglobulin G) antibodies in England.

Data Collection/Processing. We obtained random cross-sectional samples of adults from the National Health Service (NHS) patient list (near-universal coverage). We sent participants a lateral flow immunoassay (LFIA) self-test, and they reported the result online. Overall, 905 991 tests were performed (28.9% response) over 6 rounds of data collection (June 2020–May 2021).

Data Analysis/Dissemination. We produced weighted estimates of LFIA test positivity (validated against neutralizing antibodies), adjusted for test performance, at local, regional, and national levels and by age, sex, and ethnic group and area-level deprivation score. In each round, fieldwork occurred over 2 weeks, with results reported to policymakers the following week. We disseminated results as preprints and peer-reviewed journal publications.

Public Health Implications. REACT-2 estimated the scale and variation in antibody prevalence over time. Community self-testing and -reporting produced rapid insights into the changing course of the pandemic and the impact of vaccine rollout, with implications for future surveillance.

Authors: Ward, H; Atchison, C; Whitaker, M; Davies, B; Ashby, D

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: American Public Health Association
• Journal: American Journal of Public Health
• Volume: 113
• Issue: 11
• Pages: 1201-1209
• Publication date: 2023-10-11
• Acceptance date: 2023-06-28
• DOI: 10.2105/AJPH.2023.307381
• EISSN: 1541-0048
• ISSN: 0090-0036
• Language: English