136 - In-home COVID-19 Testing for Children with Medical Complexity: Feasibility and Association with School Safety Perceptions
Sunday, April 24, 2022
3:30 PM – 6:00 PM US MT
Poster Number: 136 Publication Number: 136.304
Ryan J. Coller, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Gemma G. Warner, American Family Children's Hospital, Madison, WI, United States; Sabrina Butteris, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Michelle M. Kelly, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Mary Ehlenbach, Univ of WI School of Medicine & Public Health, Madison, WI, United States; Nicole Werner, University of Wisconsin-Madison, Madison, WI, United States; Barbara J. Katz, Family Voices of Wisconsin, Madison, WI, United States; Ellen R. Wald, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Joseph A. McBride, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Kristina Devi Howell, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Madeline Q. Kieren, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Shawn Koval, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Hanna J. Barton, University of Wisconsin - Madison, Madison, WI, United States; Gregory DeMuri, Univ of Wisconsin School of Medicine and Public Health, Madison, WI, United States
Research Specialist University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, United States
Background: Deciding whether to send children with medical complexity (CMC) to school is a dilemma for families wanting to minimize COVID-19 infection risk. Access to regular COVID-19 testing for high risk individuals allows early detection, and may promote safer in-person school attendance for CMC.
Objective: To evaluate (1) feasibility of surveillance and intermittent in-home COVID-19 testing; and (2) changes in-person school attendance and parent school safety perceptions associated with in-home testing.
Design/Methods: In this prospective feasibility study, a convenience sample of 51 CMC were enrolled into twice-weekly in-home COVID-19 surveillance testing using the BinaxNOW rapid antigen platform, 5/1/2021-12/1/21. Eligible CMC were ages 5-17 years from our complex care program who attended in-person school pre-pandemic. After 3 months of twice weekly testing, families could continue surveillance testing or switch to symptom-/exposure-based testing. Parents submitted weekly testing logs. Feasibility measures included log response rates, actual vs expected test rates, testing problems, perceived importance to continue, and choosing ongoing surveillance. McNemar’s test for paired data assessed changes to in-person school attendance and safety perceptions from study entry (T1) to 12/2021 (T2).
Results: Sample characteristics of n=51 CMC are summarized in Table 1. Weekly testing log response rate was 88.1%. Of 1692 tests, 2 were positive (0.1%) and confirmed by PCR. No false positives or negatives occurred. The minimum expected number of weekly tests occurred 87.4% of the time, with median (IQR) 2 (2-2) tests/CMC/week (range 0-6). Test problems were uncommon (4.9% of tests), and included limited child cooperation (1.7%) or unavailability, e.g., hospitalized (3.2%). Continuing testing was very/extremely important in 81.4% of weekly logs. After 3 months of surveillance testing, 65% opted to continue and 35% chose symptom-/exposure-based testing. At T1, 63% were attending school in-person compared to 84% at T2 (p=0.02). School safety perceptions were not significantly different from T1 to T2 (Table 2); however, those choosing ongoing surveillance were less likely to feel that school could follow recommendations to keep their child safe (14%, vs 64% who chose intermittent testing, p< 0.001). Conclusion(s): In-home COVID-19 antigen testing is feasible for CMC surveillance and intermittent testing strategies. Although increased in-person school attendance has several potential causes, associations may exist with in-home testing preferences and safety perceptions. Table 1. Characteristics of Children Enrolled into a Pilot In-Home COVID-19 Testing Program Table 2. Changes in In-School Attendance and School Safety Perceptions Before and After Enrollment into Testing Program