key: cord-0784854-rt5ri777
authors: Mosnier, Emilie; Nevissas, Olivia; Loubière, Sandrine; Mosnier, Marine; Bosetti, Thomas; Bottero, Julie; Roux, Perrine; Monfardini, Elisabetta; Tinland, Aurélie
title: SARS-CoV-2 rapid serological tests for field-based healthcare workers in homeless communities: a mixed-methods exploratory analysis
date: 2021-06-23
journal: Public Health Pract (Oxf)
DOI: 10.1016/j.puhip.2021.100154
sha: 3c713038188692524320810f8f233e8329d9cf7f
doc_id: 784854
cord_uid: rt5ri777

OBJECTIVES: The high risk of SARS-CoV-2 transmission in homeless communities requires adapted prevention strategies for field-based healthcare workers (HCWs). Rapid serological tests (RSTs) could be an invaluable tool for HCWs to control COVID-19 transmission. This study assesses the benefits of RSTs for HCWs in Marseille, France. STUDY DESIGN: Mixed-methods exploratory analysis. METHODS: A mixed-methods approach was used, combining quantitative and qualitative data, to prospectively analyse acceptability of RSTs, prevalence of SARS-CoV-2 antibodies and prevention behaviours in 106 HCWs from 18 non-governmental organisations (NGOs) and health or social institutions in Marseille from June 1 to July 31, 2020. For the qualitative dimension, semi-structured individual interviews were conducted with 21 HCWs from 7 of 18 NGOs and institutions. RESULTS: Most of the 106 HCWs in the quantitative study reported better prevention measures at work than in their homes. Despite this, the majority reported that they felt unsafe at work in terms of COVID-19 infection risk. SARS-CoV-2 antibody seroprevalence among the study population was 6.1%. Only four HCWs refused to have an RST. The 21 qualitative interviews highlighted that HCWs were not afraid of RSTs or of any possible stigma associated with a positive serological status, although they were sometimes suspicious about RST validity. Downplaying their risk of infection was a coping strategy to keep both a sense of control and remain motivated at work. CONCLUSIONS: RSTs should be adopted as an additional tool in the strategy to protect both HCWs and healthcare service users. Additional follow-up of these observational findings is needed, especially with the increasing prevalence of vaccination in HCWs.

data, to prospectively analyse acceptability of RSTs, prevalence of SARS-CoV-2 antibodies and prevention behaviours in 106 HCWs from 18 non-governmental organisations (NGOs) and health or social institutions in Marseille from June 1 to July 31, 2020. For the qualitative dimension, semi-structured individual interviews were conducted with 21 HCWs from 7 of 18 NGOs and institutions.

Results: Most of the 106 HCWs in the quantitative study reported better prevention measures at work than in their homes. Despite this, the majority reported that they felt unsafe at work in terms of COVID-19 infection risk. SARS-CoV-2 antibody seroprevalence among the study population was 6.1%. Only four HCWs refused to have an RST.

The 21 qualitative interviews highlighted that HCWs were not afraid of RSTs or of any possible stigma associated with a positive serological status, although they were sometimes suspicious about RST validity. Downplaying their risk of infection was a coping strategy to keep both a sense of control and remain motivated at work.

Conclusions: RSTs should be adopted as an additional tool in the strategy to protect both HCWs and healthcare service users. Additional follow-up of these observational findings is needed, especially with the increasing prevalence of vaccination in HCWs.

Keywords: Covid-19; rapid serological test; Healthcare workers; testing; Public health; prevention, behaviour, perception of risk

Coronavirus disease 2019 (COVID-19) diagnosis is based on the detection of the SARS-CoV-2 virus using RT-PCR from naso-pharyngeal samples taken during active infection 1 . Rapid serological tests (RSTs), which detect SARS-CoV-2 antibodies, provide a fast diagnosis of past or recent infection, without having to send samples to centralised laboratories. Most people infected with SARS-CoV-2 develop antibodies, even asymptomatic individuals 2 . RSTs require only finger-prick blood samples. Homeless people and field-based healthcare workers (HCWs) working with this vulnerable population have a particularly high risk of COVID-19 infection 3, 4 . A rapid and easy serological test could aid HCWs in early decision making for themselves and their patients, which, when combined with other tools, may help prevent SARS-CoV-2 transmission. COVID-19 self-testing could help to increase access to and coverage of SARS-CoV-2 testing, thus contributing to improved protection measures. To the best of our knowledge, this is the first study to evaluate the acceptability of RSTs for SARS-CoV-2, measure the prevalence of SARS-CoV-2 antibodies in HCWs through RSTs performed J o u r n a l P r e -p r o o f in the field (before access to vaccination) and describe prevention behaviours in fieldbased HCWs working with homeless communities in Marseille, France.

We used a mixed-methods approach to assess acceptability of RSTs, SARS-CoV-2 antibody status and prevention behaviours in HCWs from 18 NGOs and other institutions providing care to homeless people in Marseille. The study took place from June 1 to July 31, 2020.

Individuals were eligible to participate in the study if they were aged ≥18 years and were employed as an HCW. In this study, HCWs were defined as individuals who 

The qualitative assessment was performed using face-to-face interviews. Participants were recruited from seven of the 18 participating NGOs and institutions. NGOs, institutions and participants were representative of all organisations and HCW stakeholders working in Marseille, and were also included in the quantitative part of the study. An anthropologist summarised and extracted meaningful discourse content and formulated and analysed relevant discourse themes.

Of the 106 HCWs participating in the study (i.e. study sample), 102 had an RST (4 refusals). Sex ratio (M/F) was 0.45, age range was 20-65 years (median age: 39.6 years).

The main results are summarised in Table 1. In total, 6.1% had a positive RST result (n = 6/99). HCW acceptability of RSTs was mostly good, with only 4% (n = 4/101) reporting concern. Just over one-third (36.7%, n (Table 1) More than half of the study participants (52%, n = 53/102) declared that they would be willing to have another RST within one month, if necessary.

For the qualitative section of this study, we enrolled 21 professionals (9 nurses and physicians, 12 social workers and project coordinators) from seven of the 18 participating NGOs and institutions. In total, 15 participants were women, and ages ranged from 24 to 47 years (see Supplementary table S1). The following two key themes were identified from the discussions:

1. RST is a new tool and its validity is sometimes contested. Some respondents perceived that RSTs do not have enough scientific validity. One nurse doubted the validity of the test just because it was new. Some participants were also very sceptical about the scientific discourses and communication strategies surrounding COVID-19 transmission modalities and its prevalence. "I've never felt worried about the risk of being infected by COVID-19. As social workers in charge of homeless persons with mental disorders, we are used to being exposed to many diseases: Hepatitis B, HIV, with sometimes…attacks with needles". Social worker, 30 years old, male, outreach mobile team for homeless persons with psychiatric disorders. Some HCWs reported that access to RSTs and information about their serological status did not help them to diminish work-related stress. Indeed, for a minority of respondents, not being aware of their status was easier for them. Most HCWs reported that they preferred the risk of SARS-CoV-2 infection to the risk of being excluded or 'not being where they should be' as field workers whose mission is to protect and provide care to homeless patients. This problem-avoiding strategy seemed effective for these HCWs, as they could cope with the risk of being excluded from their workplace for health reasons. Several studies on the COVID-19 pandemic have reported increased stress, anxiety and depression in HCWs facing complex situations in their work and home lives 7 . However, some authors also highlight that HCWs report a 'sense of duty' and the importance of properly performing their job 8 . Testing is widely recommended for HCWs who provide care to high-risk groups 9 . Widespread and simplified access to testing for HCWs should be implemented to identify asymptomatic individuals and prevent a transmission to coworkers and vulnerable populations. The RSTs performed in our study were easy to implement in the participating organisations providing care to the homeless because the majority of HCWs were willing to have the test and because it is relatively simple to perform. Nevertheless, training, support and information on RSTs and how to correctly J o u r n a l P r e -p r o o f perform these tests should be provided to HCWs to reduce the risk reluctance/hesitancy and improper use.

Finally, RSTs could be an important tool for exposed HCWs. Indeed, managing exposure risk and promoting vaccination are essential tools in limiting the impact of SARS-CoV-2 infection and subsequent COVID-19 disease in this workforce 9 . It is the responsibility of Other comparative studies and large prospective studies are needed to confirm the benefits of free self-RST testing in HCWs in terms of public health.

The quantitative findings reported a higher prevalence of SARS-CoV-2 antibodies following RST in HCWs than in the general population. Quantitative and qualitative data provided conflicting results on HCW acceptability of RSTs. This highlights that RSTs should be complemented with information on the advantages and limitations of this testing strategy.

RSTs are relatively cheap and easy to use, and could help reduce SARS-CoV-2 transmission as well as guide policy makers when developing prevention measures for this key healthcare population.

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We would like thank all the following: the nurses involved in the 'COVID 

The authors have no conflict of interest to declare. J o u r n a l P r e -p r o o f

X The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:J o u r n a l P r e -p r o o f