At-Home Versus Onsite COVID-19 School-based Testing: A Randomized Noninferiority Trial

• Published in: Pediatrics (Evanston) Vol. 152; no. Suppl 1; p. 1
• Main Authors: Kiene, Susan M, McDaniels-Davidson, Corinne, Lin, Chii-Dean, Rodriguez, Tasi, Chris, Nicole, Bravo, Rebecca, Moore, Vernon, Snyder, Tom, Arechiga-Romero, Marisela, Famania-Martinez, Lynnette, Carbuccia, Jennifer, Pinuelas-Morineau, Rachel, Oren, Eyal
• Format: Journal Article
• Language: English
• Published: United States American Academy of Pediatrics 01.07.2023
• Subjects: Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - prevention & control; COVID-19 diagnostic tests; COVID-19 Testing; Disease transmission; Humans; Onsite; Participation; Pediatrics; School districts; School Health Services; Schools; Students; Supplement
• ISSN: 0031-4005; 1098-4275; 1098-4275
• DOI: 10.1542/peds.2022-060352F

Equitable access to coronavirus 2019 (COVID-19) screening is important to reduce transmission and maintain in-person learning for middle school communities, particularly in disadvantaged schools. Rapid antigen testing, and at-home testing in particular, could offer substantial advantages over onsite testing from a school district's perspective, but it is unknown if engagement in at-home testing can be initiated and sustained. We hypothesized that an at-home COVID-19 school testing program would be noninferior to an onsite school COVID-19 testing program with regard to school participation rates and adherence to a weekly screening testing schedule. We enrolled 3 middle schools within a large, predominantly Latinx-serving, independent school district into a noninferiority trial from October 2021 to March 2022. Two schools were randomized to onsite and 1 school to at-home COVID-19 testing programs. All students and staff were eligible to participate. Over the 21-week trial, at-home weekly screening testing participation rates were not inferior to onsite testing. Similarly, adherence to the weekly testing schedule was not inferior in the at-home arm. Participants in the at-home testing arm were able to test more consistently during and before returning from school breaks than those in the onsite arm. Results support the noninferiority of at-home testing versus onsite testing both in terms of participation in testing and adherence to weekly testing. Implementation of at-home COVID-19 screening testing should be part of schools' routine COVID-19 prevention efforts nationwide; however, adequate support is essential to ensure participation and persistence in regular at-home testing.