Acceptability of Covid-19 self-testing among Primary Health Care users
DOI:
https://doi.org/10.11606/s1518-8787.2026060006399Keywords:
Self-testing, Covid-19 testing, Primary Health CareAbstract
OBJECTIVE: To identify factors associated with the acceptability of Covid-19 self-testing among socioeconomically vulnerable populations. METHODS: Cross-sectional study using data from the “TQT Covid-19” project, which involved users from 19 primary health care (PHC) units located in socioeconomically vulnerable areas in Salvador (BA) and Rio de Janeiro (RJ), Brazil. Data were collected between July 2022 and July 2023. Descriptive analysis of Covid-19 self-test acceptability was performed, and logistic regression models were used to estimate factors associated with acceptability, with respective 95% confidence intervals (95%CI). RESULTS: Among 7,939 study participants, 45.8% (95%CI 44.75–46.95) reported willingness to use a Covid-19 self-test. In the analysis of associated factors, regarding sociodemographic profile, non-Black individuals (ORa = 1.17; 95%CI 1.02–1.34), cisgender men (ORa = 1.23; 95%CI 1.12–1.37), and participants with higher educational levels (ORa = 1.60; 95%CI 1.43–1.79) were more likely to accept the self-test. Those with prior knowledge of the self-test (ORa = 2.33; 95%CI 2.11–2.58) and those previously diagnosed with Covid-19 (ORa = 1.17; 95%CI 1.05–1.28) also reported higher acceptance. CONCLUSIONS: Provision of Covid-19 self-testing should be considered as a complement to testing within the public health system, especially due to its acceptance among vulnerable populations and the difficulties in accessing testing in many Brazilian regions. During periods of increased Covid-19 incidence, self-testing may serve as an important strategy for mass case detection, provided that access and knowledge are expanded so communities can play an active role in SARS-CoV-2 epidemiological surveillance.
References
1. Brasil. Brasil confirma primeiro caso do novo coronavírus [Internet]. Brasil; 2020 [cited Dec 22, 2023]. Available from: https://www.gov.br/pt-br/noticias/saude-e-vigilancia-sanitaria/2020/02/brasil-confirma-primeiro-caso-do-novo-coronavirus
2. Martínez-Pérez GZ, Shilton S, Saruê M, Cesario H, Banerji A, Batheja D, et al. Self-testing for SARS-CoV-2 in São Paulo, Brazil: results of a population-based values and attitudes survey. BMC Infect Dis. 2022;22(1):720. https://doi.org/10.1186/s12879-022-07706-7
3. Green RK, Manchola C, Gerth-Guyette E, Silva MO, Stephanie R, dos Santos Soares T, et al. Integration of serial self-testing for Covid-19 as part of contact tracing in the Brazilian public health system: A pragmatic trial protocol. PLoS One. 2023;18(10):0284659. https://doi.org/10.1371/journal.pone.0284659
4. Gandjour A. Benefits, risks, and cost-effectiveness of Covid-19 self-tests a consumer’s perspective. BMC Health Serv Res. 2022;22(1):47. https://doi.org/10.1186/s12913-021-07277-4
5. World Health Organization. Recommendations for national SARS-CoV-2 testing strategies and diagnostic capacities [Internet]. World Health Organization; 2021 [cited Dec 21, 2023]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-lab-testing-2021.1-eng
6. World Health Organization. SARS-CoV-2 antigen-detecting rapid diagnostic tests: an implementation guide [Internet]. World Health Organization; 2020. Available from: https://www.who.int/publications/i/item/9789240017740
7. Brasil. Anvisa regulamenta a utilização de autotestes para Covid-19 [Internet]. Brasil: Anvisa; 2022 [cited Dec 22, 2023]. Available from: https://www.gov.br/anvisa/pt-br/assuntos/noticias-anvisa/2022/anvisa-regulamenta-a-utilizacao-de-autotestes-para-Covid-19
8. Do Prado MF, De Paula Antunes BB, Dos Santos Lourenço Bastos L, Peres IT, De Araújo Batista Da Silva A, Dantas LF, et al. Análise da subnotificação de Covid-19 no Brasil. Rev Bras Ter Intensiva. 2020;32(2):224-8. https://doi.org/10.5935/0103-507X.20200030
9. Floss M, Franco CM, Malvezzi C, Silva KV, dos Reis Costa B, de Lima e Silva VX, et al. A pandemia de Covid-19 em territórios rurais e remotos: perspectiva de médicas e médicos de família e comunidade sobre a atenção primária à saúde. Cad Saúde Pública. 2020;36(7):e00108920. https://doi.org/10.1590/0102-311X00108920
10. Magno L, Rossi TA, de Mendonça-Lima FW, dos Santos CC, Campos GB, Marques LM, et al. Desafios e propostas para ampliação da testagem e diagnóstico para Covid-19 no Brasil. Ciên Saúde Colet. 2020;25(9):3355-64. https://doi.org/10.1590/1413-81232020259.17812020
11. Pescarini JM, Aquino EML, Sileira IH, Aquino R, Souza-Filho JA. Social distance measures to control the Covid-19 pandemic: Potential impacts and challenges in Brazil. Ciên Saúde Colet. 2020;7823-30.
12. Torres TS, Luz PM, Coelho LE, Jalil C, Falco GG, Sousa LP, et al. SARS-CoV-2 testing disparities across geographical regions a large metropolitan area in Brazil: Results a web-based survey among individuals interested in clinical trials for Covid-19 vaccines. Brazilian J Infect Dis. 2021;25(4):101600. https://doi.org/10.1016/j.bjid.2021.101600
13. Khandker SS, Hashim NHHN, Deris ZZ, Shueb RH, Islam MA. Diagnostic accuracy of rapid antigen test kits for detecting SARS-CoV-2: a systematic review and meta-analysis of 17,171 suspected Covid-19 patients. J Clin Med. 2021;10(16):3493. https://doi.org/10.3390/jcm10163493
14. Machado CV, Pereira AMM, Freitas CM. Políticas e sistemas de saúde em tempos de pandemia: nove países, muitas lições. Série Info. In: Fiocruz, editor. Políticas e sistemas de saúde em tempos de pandemia: nove países, muitas lições. Rio de Janeiro: Fiocruz; 2022. 344 p.
15. Lane-Barlow C, Thomas I, Horter L, Fleurence R, Green J, Juluru K, et al. Experiences of health departments on community engagement and implementation of a Covid-19 self-testing program. J Public Heal Manag Pract. 2023;29(4):539-46. https://doi.org/10.1097/phh.0000000000001688
16. Thomas C, Shilton S, Thomas C, Iye CM, Martínez-Pérez GZ. Covid-19 self-testing, a way to “live side by side with the coronavirus”: Results a qualitative study in Indonesia. PLOS Glob Public Heal. 2022;2(10):e0000514. https://doi.org/10.1371/journal.pgph.0000514
17. Undelikwo VA, Shilton S, Folayan MO, Alaba O, Reipold EI, Martínez-Pérez GZ. Covid-19 self-testing in Nigeria: Stakeholders’ opinions and perspectives on its value for case detection. PLoS One. 2023;18(4):0282570. https://doi.org/10.1371/journal.pone.0282570
18. Brasil. Ministério da Saúde. Diretrizes para a distribuição do autoteste de HIV no Brasil [Internet]. Brasil: Ministério da Saúde; 2022 [cited Nov 4, 2025]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_distribuicao_autoteste_hiv.pdf ISBN
19. Magno L, Rossi TRA, Castanheira D, Torres TS, Santos CC dos, Soares F, et al. Expansion of testing, isolation, quarantine, e-health and telemonitoring strategies in socioeconomically vulnerable neighbourhoods at primary healthcare in the fight against Covid-19 in Brazil: a study protocol of a multisite testing intervention using a mixed method approach. BMJ Open. 2023;13(6):e068016. https://doi.org/10.1136/bmjopen-2022-068016
20. Hosmer DW, Lemeshow S. Applied logistic regression [Internet]. 2nd ed. New York: Wiley Interscience Publication; 2000 [cited May 6, 2018]. 376 p. Available from: http://resource.heartonline.cn/20150528/1_3kOQSTg.pdf
21. Louart S, Hedible GB, Ridde V. Assessing the acceptability of technological health innovations in sub-Saharan Africa: a scoping review and a best fit framework synthesis. BMC Health Serv Res. 2023;23(1):930. https://doi.org/10.1186/s12913-023-09897-4
22. Folayan M, Shilton S, Undelikwo V, Alaba O, Amusan R, Ibrahim M, et al. People’s willingness to use Covid-19 self-testing in Nigeria: a cross-sectional survey. BMJ Open. 2023;13(1):e063323. https://doi.org/10.1136/bmjopen-2022-063323
23. Brumwell AN, Babatunde GB, Wilson MW, le Roux K, Marks MM, Adam JK, et al. Values of Covid-19 self-testing among urban and rural South Africans: a cross-sectional survey. Prev Med Reports. 2023;32:102114. https://doi.org/10.1016/j.pmedr.2023.102114
24. Manguro G, Shilton S, Omenda S, Owira P, Batheja D, Banerji A, et al. Are kenyans likely to use Covid-19 self-testing kits? Results a cross-sectional survey. Int J Public Health. 2022;67:1604918. https://doi.org/10.3389/ijph.2022.1604918
25. Thomas C, Shilton S, Thomas C, Batheja D, Goel S, Mone Iye C, et al. Values and preferences of the general population in Indonesia in relation to rapid Covid-19 antigen self-tests: A cross-sectional survey. Trop Med Int Heal. 2022;27(5):522-36. https://doi.org/10.1111/tmi.13748
26. Brasil. Ministério da Saúde. Covid-19 Casos e Óbitos [Internet]. Brasil: Ministério da Saúde; 2023 [cited Dec 22, 2023]. Available from: https://infoms.saude.gov.br/extensions/Covid-19_html/Covid-19_html.html
27. Torres-Slimming PA, Carcamo C, Martínez-Pérez GZ, Mallma P, Pflucker C, Shilton S. Rapid SARS-CoV-2 antigen detection self-tests to increase Covid-19 case detection in Peru: qualitative study. JMIR Form Res. 2023;7:e43183. https://doi.org/10.2196/43183
28. Brasil. Conselho Nacional de Saúde. CNS recomenda que Ministério da Saúde distribua autotestes pelo SUS e garanta orientações à população [Internet]. Brasil: Ministério da Saúde; 2022 [cited Oct 9, 2024]. Available from: https://www.gov.br/conselho-nacional-de-saude/pt-br/assuntos/noticias/2022/janeiro/cns-recomenda-que-ministerio-da-saude-distribua-autotestes-pelo-sus-e-garanta-orientacoes-a-populacao
29. Ciccone EJ, Conserve DF, Dave G, Hornik CP, Kuhn ML, Herling JL, et al. At-home testing to mitigate community transmission of SARS-CoV-2: protocol for a public health intervention with a nested prospective cohort study. BMC Public Health. 2021;21(1):2209. https://doi.org/10.1186/s12889-021-12007-w
30. Anand A, Vialard F, Esmail A, Khan FA, O’Byrne P, Routy JP, et al. Self-tests for Covid-19: What is the evidence? A living systematic review and meta-analysis (2020-2023). PLOS Glob Public Heal. 2024;4(2):e0002336. https://doi.org/10.1371/journal.pgph.0002336
31. Stohr JJJM, Zwart VF, Goderski G, Meijer A, Nagel-Imming CRS, Kluytmans-van den Bergh MFQ, et al. Self-testing for the detection of SARS-CoV-2 infection with rapid antigen tests for people with suspected Covid-19 in the community. Clin Microbiol Infect. 2022;28(5):695-700. https://doi.org/10.1016/j.cmi.2021.07.039
32. Herbert C, Shi Q, Kheterpal V, Nowak C, Suvarna T, Durnan B, et al. Use of a digital assistant to report Covid-19 rapid antigen self-test results to health departments in 6 US communities. JAMA Netw Open. 2022;5(8):E2228885. https://doi.org/10.1001/jamanetworkopen.2022.28885
33. Mukoka M, Sibanda E, Watadzaushe C, Kumwenda M, Abok F, Corbett EL, et al. Covid-19 self-testing using antigen rapid diagnostic tests: Feasibility evaluation among health-care workers and general population in Malawi. PLoS One. 2023;18(7):e0289291. https://doi.org/10.1371/journal.pone.0289291
34. Agustí C, Martínez-Riveros H, González V, Fernández-Rivas G, Díaz Y, Montoro-Fernandez M, et al. Feasibility of an online antigen self-testing strategy for SARS-CoV-2 addressed to health care and education professionals in Catalonia (Spain). the TESTA’T- Covid Project. PLoS One. 2022;17(9):e0275006. https://doi.org/10.1371/journal.pone.0275006
35. Daniore P, Nittas V, Ballouz T, Menges D, Moser A, Hoglinger M, et al. Performance of the Swiss digital contact-tracing app over various SARS-CoV-2 pandemic waves: repeated cross-sectional analyses. JMIR Public Heal Surveill. 2022;8(11):e41004. https://doi.org/10.2196/41004
36. Schilling J, Moeller FG, Peterson R, Beltz B, Joshi D, Gartner D, et al. Testing the acceptability and usability of an ai-enabled Covid-19 diagnostic tool among diverse adult populations in the US. Qual Manag Heal Care. 2023;32(Suppl. 1):S35-44. https://doi.org/10.1097/qmh.0000000000000396
37. Cobo B, Cruz C, Dick PC. Desigualdades de gênero e raciais no acesso e uso dos serviços de atenção primária à saúde no Brasil. Ciên Saúde Colet. 2021;26(9):4021-32. https://doi.org/10.1590/1413-81232021269.05732021
38. Goggolidou P, Hodges-Mameletzis I, Purewal S, Karakoula A, Warr T. Self-testing as an invaluable tool in fighting the Covid-19 pandemic. J Prim Care Community Health. 2021;12:21501327211047782. https://doi.org/10.1177/21501327211047782
39. IBGE. Trabalho, renda e moradia: desigualdades entre brancos e pretos ou pardos persistem no país. Estatísticas Sociais [Internet]. IBGE; 2020 [acessado em 4 dez. 2025]. Disponível em: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/29433-trabalho-renda-e-moradia-desigualdades-entre-brancos-e-pretos-ou-pardos-persistem-no-pais
40. López LC. O conceito de racismo institucional: Aplicações no campo da saúde. Interface Commun Heal Educ. 2012;16(40):121-34. https://doi.org/10.1590/S1414-32832012005000004
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Copyright (c) 2026 Fabiane Soares, Laio Magno, Thaís Regis Aranha Rossi, Suelen Seixas, Thiago Silva Torres, Débora Castanheira, Helena Lima, Ana Paula Prates, Valdiléa Gonçalves Veloso, Inês Dourado
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