How self-collection is making healthcare more accessible.

In the wake of the Covid-19 pandemic, calls for stronger testing have spurred new solutions. These include procedures for tracing Covid-19 cases, commercially available rapid home tests, and methods for sending self-collected samples to testing laboratories.

Two years after the start of the Covid-19 pandemic, researchers and diagnosticians are exploring the following questions to improve public health: How can we expand the collection of samples in non-clinical settings and then in the laboratory? How can self-examination and sample collection improve health care?

Covid-19 ignites trend of at-home sample collection.

Self-collection of specimens for Covid-19 testing can help reduce exposure to SARS-CoV-2 and allow for higher testing frequency when appointments and capacity are limited in clinical settings. At-home specimen collection—in this case, the process of collecting a nasal or saliva sample and sending the sample to a clinical laboratory, says Dr. Susan Harrington, director of microbiology processing at the Cleveland Clinic. polymerase chain reaction (PCR) test– A growing trend in healthcare could dramatically change how we test for viral infections.

“In-house sample collection was used during the Covid-19 operation, either because we didn’t have enough rotating appointments or we didn’t have enough staff,” Harrington said. “Being able to collect a saliva sample or a nasal swab fits well with telemedicine. We’re definitely seeing more inquiries from our physicians who are interested in telemedicine approaches. It helps reach patients who don’t live close to a test site, as well as patients who can’t leave their homes.”

In June 2020, a study by the University of Washington and UnitedHealth Group It showed that self-collection of samples for the Covid-19 PCR test yielded similar results with accuracy. PCR testing where samples are collected in clinical settings by healthcare professionals. The authors also suggest how testing sites can reduce the amount of personal protective equipment (PPE) required for staff and help provide a “more comfortable patient experience.” Another study published in September 2020 Individuals’ willingness to provide self-collected samples Testing for covid-19. Of the more than 1,400 respondents, 90% said they would be willing to collect saliva samples or throat swab samples at home for further testing, with very few participants saying they would be willing to provide these types of samples in clinical settings. Researchers questioned the general practice of self-collecting samples for Covid-19 testing. A March 2022 survey surveyed more than 1,000 participants in Atlanta and found Most participants mentioned a positive experience during self-collectionMore than 79% of participants said “easy and comfortable”.

At the Cleveland Clinic, self-collection practices have been particularly helpful for testing patients for COVID-19 entering the health system’s facilities for procedures or requiring an overnight stay at the facility. Harrington also said that self-collection can reduce the risk to immunocompromised patients who may face additional exposure by entering a clinical setting. During the Covid-19 emergency, when thousands of health care workers stayed home after developing symptoms of the new coronavirus, self-isolation helped reduce potential exposures in clinical settings.

Self-collection for testing for sexually transmitted infections (STI).

There is more demand than ever for home testing for other types of infections, including STDs. Before the Covid-19 pandemic, Chlamydia (caused by bacteria). Chlamydia trachomatis) was the most commonly recognized infectious disease in the US (since 1995 when it received the ‘notifiable disease’ label).. Chlamydia, now second only to Covid-19, followed by gonorrhea (because Neisseria gonorrhoeae) and syphilis (in case of Treponema pale), respectively. “STDs occur faster than most infectious diseases, so we need to do something to improve our control efforts,” said President Dr. Barbara van der Pol. International Association for Research in Sexually Transmitted Diseases and Professor of Medicine and Public Health at the University of Alabama at Birmingham.

For patients with Medicaid, assigned to women at birth and under the age of 25, for example, the percentage of individuals diagnosed each year for STIs rarely breaks 60%. For individuals in the same demographic with private insurance, it’s closer to 50%. “Think about the people who have to be screened every year who don’t get the service or who don’t get the service if they go into a clinical setting,” van der Pol said. A compelling option to help increase the frequency of annual STD testing: Because of the invasive nature of some STD tests and the stigma surrounding this type of medical test, van der Pol says self-collection allows individuals to take responsibility. Healthcare in the most convenient and accessible way for them.

Building a self-assembly process

At Cleveland Clinic, self-collection items are collected by a third-party supplier, then distributed to local warehouses. Covid-19 kits typically include a set of instructions, a sterile nasal swab, 3 mL of saline solution, a biohazard bag, and a sealed envelope. After self-collection is complete, they can be disposed of in kit collection bins designated by the health system outside their pharmacies and point of care locations. These bins are cleaned by couriers at least once a day, and the health system’s molecular testing lab runs tests within 24 hours of a sample being taken. In a speech ASM Microb By June 2022, Harrington recommends considering the following questions when preparing all types of self-assembly kits, not just for Covid-19 tests.

• How is the kit manufactured and assembled?

• How is the kit stored (eg, is there a specific temperature at which samples are stored)?

• How is the kit available (eg, is the kit available directly to consumers or is the kit only available with a prescription)?

• How are samples collected from individuals at home?

• How will specimens be returned to the clinical laboratory (eg, by mail, drop-off point)?

Harrington emphasizes the importance of including easy-to-follow directions for each self-assembly kit. For example, Cleveland Clinic patients can access information through the health system’s website, instructional videos and FAQs, in addition to written instructions embedded directly into the device.

When it comes to home STD testing kits, how the samples are collected is key. Van der Pol recommends collecting samples by swab instead of urine. As a 2017 Survey of Public Health Laboratories, while vaginal swabs are more effective in detecting infections, most testing practices require urine samples. In clinical office settings, residual sterile midstream urine is often recommended for those assigned to a female at birth, as it prevents bacteria around the urethra from contaminating the specimen. However, van der Pol explained, “The pure urine in the middle river may be missing about 20% of infections.” A primary urine sample for those assigned male at birth and a sample for those assigned female at birth They are more likely to produce accurate results.

Therefore, for indoor sample collection, It makes sense to try a swab, both in practicality and effectiveness. “When you think about collecting at home, individuals can send it in because it’s a dry sample and it’s an easy sample to get, so they’re going to wash them,” she said. Emphasizing the importance of taking data into account to develop evidence-based test models with maximum effectiveness, van der Pol said they are suitable for all genders who perform at-home sample collection.

Lessons learned from covid-19

With the need for immediate test results during the Covid-19 pandemic, patient expectations of tests have changed. As a result of the pandemic, much infrastructure has been put in place to develop home-collected and diagnostic kits for infections other than Covid-19. “This is a silver lining from the Covid-19 pandemic,” van der Pol said. “People have learned how to do over-the-counter testing, we have the technology, and people have spent a fair amount of money to make the reporting process work for local health department jurisdictions. So there are solutions we can implement now. In the future, researchers and diagnosticians will have access to at-home self-collection and testing to ensure equitable access for all.” They will continue to research how to better develop and deploy tools.

“We need a new equity-based paradigm that really considers all the issues that prevent people from accessing these services,” van der Pol said. “Laboratories need to be aware of the issues around this topic, including sample efficiency issues, which are critical. Home collection management and home testing are here to stay, and we need to get on board and figure out how to implement these practices.”

Research done in this article by ASM MicrobAmerican Society for Microbiology Annual Meeting, June 9-13, 2022 in Washington, DC

Continue learning about this important topic in the new ASM Clinical Public Health Webinar Series: The Growing Opportunity for Self-Collection and Self-Testing in Clinical Microbiology. This 3-part series explores the current status of self-collection tests for respiratory viruses and sexually transmitted infections. Get up to date on September 21, 2022 while earning up to 3 continuing education credits.