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The rise and fall of SARS-CoV-2 rapid antigen self-tests at primary care level: a Portuguese case-study
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Orientador(es)
Resumo(s)
Background/Aim: SARS-CoV-2 rapid antigen self-tests are available, allowing individuals to diagnose a SARS-CoV-2 infection prior to a consultation with a healthcare professional. Self-testing may affect the general practitioner (GP) consultation behaviour and represent a selection bias in primary care vaccine effectiveness (VE) studies.
The aim of this study was to describe self-testing patterns and differences between self-testers and non-self-testers in primary care in Portugal in the 2022-23, 2023-24 and 2024-25 seasons.
Methods: Data (September 2022-March 2025) from a primary care VE study (VEBIS Primary Care study) was used, and were included patients aged 60+ with Acute Respiratory Infection (ARI) consulting a GP. Data on demographics, vaccination, self-test use, laboratory results (RT-PCR positive for SARS-CoV-2 - Cases; Negative - Controls) and clinical status was collected.
Results: Of the 382 patients included (47 cases, 335 controls), 67 (40%), 53 (43%) and 10 (11%) performed a self-test in the 2022-23, 2023-24 and 2024-25 seasons, respectively. Patients that self-tested were more likely to be female (72%, 57%, and 90%) and aged 60–79yo (94%, 62%, 70%) across all seasons. Self-tests positivity increased across the seasons (6%, 25%, 80%).
Those who self-tested had a lower SARS-CoV-2 positivity rate in 2022-23 (10% vs. 14%) but higher in 2023-24 (23% vs. 14%) and 2024-25 (10% vs. 4%) season than those that not self-tested. Similarly, a lower prevalence of chronic conditions (64% vs. 79%) was observed in 2022-23 but higher in 2023-24 (85% vs. 84%) and 2024-25 (100% vs. 82%) seasons.
Seasonal COVID-19 vaccination rate was lower in 2022-23 (39% vs. 53%) and 2023-24 (30% vs. 33%) but higher in 2024-25 (30% vs. 26%) season for those who self-tested.
In the 2022-23 and 2023-24 seasons, the increase and decrease of self-testing overlapped with the months with the highest prevalence of ARI cases. In the 2024-25 season, self-testing was lower and did not overlap with trends of ARI cases.
Conclusions: Results suggest that the potential negative association between vaccination and self-testing (unvaccinated patients were more likely to self-test) practically disappeared in the following seasons. In the present season, the use of self-tests decreased and their use does not reflect the notification of ARI cases, that is, in periods with a greater number of cases there is no increase in self-testing. However, the small sample size limited further analysis, highlighting the need for larger studies with vaccine effectiveness estimates stratified by self-testing.
Descrição
Abstract publicado em: Gac Sanit. 2025;39(S2):329.
Palavras-chave
Primary Care SARS-CoV-2 Acute Respiratory Infection (ARI) Vaccine Effectiveness Cuidados de Saúde Observação em Saúde e Vigilância Infecções Respiratórias