Self-swabbing versus assisted swabbing for viral detection by qRT-PCR: the experience from SARS-CoV-2 based on a meta-analysis of six prospectively designed evaluations conducted in a UK setting

Fowler, T; Chapman, D; Futschik, ME; Tunkel, SA; Blandford, E; Turek, E; Kolade, O; da Cunha, SS; Dodgson, A; Klapper, P; Sudhanva, M; Davies, L; Hill, S; Hopkins, S; Peto, T

Journal article

Self-swabbing versus assisted swabbing for viral detection by qRT-PCR: the experience from SARS-CoV-2 based on a meta-analysis of six prospectively designed evaluations conducted in a UK setting

Abstract:: Purpose: In April 2020, the UK Government implemented NHS Test and Trace to provide SARS-CoV-2 quantitative reverse transcription polymerase chain reaction (qRT-PCR) testing for the public, with nose-and-throat swabbing for samples performed by trained staff. Self-swabbing (SS) would allow rapid scale-up of testing capacity and access. Six studies were undertaken to determine whether SS was as effective for detecting SARS-CoV-2 as swabbing performed by trained staff. Methods: Six prospective studies were conducted between April–October 2020, using six swab/media combinations. Differences between assisted swabbing (AS) and SS were evaluated for concordance, positivity, sensitivity, cycle threshold (Ct) values and void rates. Statistical analysis was performed using 95% confidence intervals (CIs), paired t-tests and model-based methods. Results: Overall, 3,253 individuals were recruited (median age 37 years, 49% female), with 2,933 having valid paired qRT-PCR results. Pooled concordance rate was 98% (95% CI: 96%, 99%). Positivity rate differences for SS (8.1%) and AS (8.4%) and differences in pooled sensitivities between SS (86%; 95% CI: 78%, 92%) and AS (91%; 95% CI: 78%, 96%) were nonsignificant. Both types of swabbing led to pooled void rates below 2% and strongly correlated Ct values. Age, sex and previous swabbing experience did not have a significant impact on concordance or sensitivity. Conclusion: The UK adopted a policy to promote self-testing for SARS-CoV-2 based on data demonstrating equivalence of SS versus AS. Positive outcomes with SS are likely generalisable to testing for other respiratory pathogens, and we consider self-sampling and self-testing essential for future pandemic preparedness.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Fowler, T., Chapman, D., Futschik, M. E., Tunkel, S. A., Blandford, E., Turek, E., Kolade, O., da Cunha, S. S., Dodgson, A., Klapper, P., Sudhanva, M., Davies, L., Hill, S., Hopkins, S., & Peto, T. (2024). Self-swabbing versus assisted swabbing for viral detection by qRT-PCR: the experience from SARS-CoV-2 based on a meta-analysis of six prospectively designed evaluations conducted in a UK setting. European Journal of Clinical Microbiology and Infectious Diseases, 43(8), 1621–1630.

MLA Style

Fowler, T., et al. “Self-Swabbing versus Assisted Swabbing for Viral Detection by QRT-PCR: the Experience from SARS-CoV-2 Based on a Meta-Analysis of Six Prospectively Designed Evaluations Conducted in a UK Setting.” European Journal of Clinical Microbiology and Infectious Diseases, vol. 43, no. 8, Springer, 2024, pp. 1621–30.

Chicago Style

Fowler, T, D Chapman, ME Futschik, SA Tunkel, E Blandford, E Turek, O Kolade, et al. 2024. “Self-Swabbing versus Assisted Swabbing for Viral Detection by QRT-PCR: the Experience from SARS-CoV-2 Based on a Meta-Analysis of Six Prospectively Designed Evaluations Conducted in a UK Setting.” European Journal of Clinical Microbiology and Infectious Diseases 43 (8): 1621–30.
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