Patterns of SARS-CoV-2 testing preferences in a national cohort in the United States: Latent class analysis of a discrete choice experiment.

BACKGROUND Inadequate screening and diagnostic testing in the United States throughout the first several months of the COVID-19 pandemic led to undetected cases transmitting disease in the community and an underestimation of cases. Though testing supply has increased, maintaining testing uptake remains a major public health priority in efforts to control community transmission considering the availability of vaccinations and threats from variants. OBJECTIVE To identify patterns of preferences for SARS-CoV-2 screening and diagnostic testing prior to widespread vaccine availability and uptake. METHODS We conducted a discrete choice experiment (DCE) among participants in the national prospective Communities, Households, and SARS-CoV-2 Epidemiology (CHASING COVID) Cohort Study from July 30-September 8, 2020. The DCE elicited preferences for SARS-CoV-2 test type, specimen type, testing venue, and result turnaround time. We used latent class multinomial logit to identify distinct patterns of preferences related to testing as measured by attribute level part-worth utilities, and conducted a simulation based on the utility estimates to predict testing uptake if additional testing scenarios were offered. RESULTS Of the 5,098 invited cohort participants, 4,793 participants (94%) completed the DCE. Five distinct patterns of SARS-CoV-2 testing emerged. "Non-invasive home testers" (920, 19.2% of participants) were most influenced by specimen type and favored less invasive specimen collection methods, with saliva most preferred; this group was the least likely to opt-out of testing. "Fast-track testers" (1,235, 25.8%) were most influenced by result turnaround time and favored immediate and same day turnaround time. Among "Dual testers" (889, 18.5%) test type was the most important attribute and they preferred both antibody and viral tests. "Non-invasive dual testers" (1,578, 32.9%) were most strongly influenced by specimen type and test type, preferring saliva and cheek swab specimens and both antibody and viral tests. Among "Hesitant home testers" (171, 3.6%) venue was the most important attribute; notably, this group was the most likely to opt-out of testing. In addition to variability in preferences for testing features, heterogeneity was observed in the distribution of certain demographic characteristics (age, race/ethnicity, education, and employment), history of SARS-CoV-2 testing, COVID-19 diagnosis, and concern about the pandemic. Simulation models predicted that testing uptake would increase from 81.6% (with a status quo scenario of polymerase chain reaction by nasal swab in a provider's office and a turnaround time of several days) to 98.1% by offering additional scenarios using less invasive specimens, both viral and antibody tests from a single specimen, faster turnaround time, and at-home testing. CONCLUSIONS We identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options would likely increase testing uptake in line with public health goals. Additional studies may be warranted to understand if preferences for testing have changed since the availability and widespread uptake of vaccines. CLINICALTRIAL