COVID-19 testing acceptance among symptomatic individuals screened for a randomized clinical trial in The Gambia

Testing is a critical component to control disease outbreaks. The screening process required to enrol study participants from individuals with suspected COVID-19 disease in a clinical trial, presented an opportunity to explore factors that influence the willingness to be tested for COVID-19.

We analyzed data from individuals with symptoms suggestive of mild-moderate COVID-19 in two different health facilities in Western Gambia. As part of pre-enrollment screening for recruitment into a COVID-19 drug trial, we recorded clinical, epidemiological, and demographic information. Individuals who consented had a nasopharyngeal and/or oropharyngeal sample collected for SARS-CoV-2 testing. We compared consenting and non-consenting individuals using univariate and multivariable logistic regression and calculated adjusted odds ratio. Over-time trends were visualised using a 30-day moving sum for participants who consented.

Among the 1361 suspected COVID-19 individuals identified between January 2021 and August 2022, 33.4 % (458/1361) consented to be tested for SARS-CoV-2. In the multivariate analysis, history of smoking (aOR: 3.07, 95 %CI: 1.60-5.88 p < 0.001), high educational level (aOR: 6.32, 95 %CI: 3.84-10.39 p < 0.001), history of travel (aOR: 2.94, 95 %CI: 1.20-7.22, p = 0.019), and loss of smell (aOR: 4.00, 95 %CI: 2.24-7.17 p = 0.002,) were significantly associated with acceptance to COVID-19 testing. The 30-day moving sum showed a downward trend of testing acceptance over time.

Although testing acceptance was very low, individuals with recognised risk factors for COVID-19 were more likely to accept testing. Early and sustained information about these risk factors particularly targeting individuals in low-education cadres may enhance testing uptake during a pandemic.