Respiratory multi-viral rapid-antigen point-of-care tests in New Zealand primary care: a mixed-methods pilot

Rapid, cost-effective diagnosis of acute respiratory infections is now possible using multi-viral rapid-antigen point-of-care tests (MVRA-POCTs) with high sensitivity and specificity. These offer a realistic alternative to polymerase chain reaction tests in primary care. However, evidence of acceptability and clinical utility in this setting is limited.

To pilot feasibility of integrating MVRA-POCTs into routine primary care, and investigate patient and clinician attitudes and behaviours.

A prospective mixed-methods pilot study in seven New Zealand (NZ) primary care clinics during winter 2023.

Patients with acute respiratory symptoms received an MVRA-POCT (instead of COVID-19-only). Outcomes and acceptability were assessed via audits of electronic medical records, clinician and patient surveys, and interviews and focus groups with patients and clinic staff.

Swab results were recorded from a demographically diverse cohort of 1754 patients; 14% tested positive for any virus (n = 246/1754). All clinicians and most patients surveyed positively evaluated the test. All clinicians incorporated the MVRA-POCT into practice and found it useful. In total, 63% of prescribers (n = 26/41) reported results influenced antibiotic prescribing; 12% (n = 5/41) supported decisions about secondary care referrals for 12% (n = 5/41). All patient responders who tested positive (n = 39) and most testing negative (n = 172/180, 96%) would like the MVRA-POCT in future. Patients testing positive self-reported as more likely to follow non-pharmaceutical interventions to reduce transmission compared with those testing negative.

MVRA-POCTs were well-accepted and readily incorporated into practice. Routine integration into primary care could potentially improve management of common respiratory illnesses and promote patient behaviour change to reduce transmission.