COVID-19 test acceptance low among adults on hemodialysis
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Key takeaways:
- Researchers compared a strategy of COVID-19 testing every 2 weeks to an approach with testing frequency tied to local infection rates.
- In both groups, the test acceptance rate was 8%.
COVID-19 test acceptance was low among adults on hemodialysis, according to a nationwide cluster trial that evaluated two SARS-CoV-2 assessment strategies at U.S. dialysis facilities.
“Surveillance screening for infections in dialysis facilities has the potential to mitigate adverse effects of viral illness,” Maria Montez-Rath, PhD, of the Stanford University School of Medicine in Palo Alto, California, wrote with colleagues. “Early diagnosis of viral illness among patients receiving maintenance dialysis could alert clinicians to undertake more frequent assessment, for example, for potential respiratory complications or hypotension.”
The study took place from February 2023 to July 2023 and included 2,389 adults (mean age, 64 years; 56% men) at 57 randomly selected U.S. hemodialysis facilities. Of the cohort, 37% were Black, 37% were white and 14% were Hispanic; 67% had diabetes.
Researchers aimed to determine whether patients would voluntarily take regular SARS-CoV-2 tests at centers located across 22 states. Overall, 12,553 SARS-CoV-2 tests were offered to compare a static strategy of tests every 2 weeks to a dynamic approach, varying from weekly to monthly, with frequency tied to community COVID-19 infection prevalence.
In both testing strategies, the test acceptance rate was 8%, data showed. Dynamic interval testing was not better than static testing, researchers found. Median number of tests offered per patient was six in the static group and four in the dynamic group, according to the researchers.
Of 503 patients who accepted at least one test, the median proportion of tests accepted was 16% in the static arm and 50% for the dynamic arm.
Montez-Rath and colleagues found three groups were more likely to accept multiple tests: older patients (OR = 1.08; 95% CI, 1.01-1.16), patients with diabetes (OR =1.59; 95% CI, 1.18-2.16) and women (OR = 1.30; 95% CI, 0.98-1.73).
Patients identified as Hispanic were more likely than those identified as white (OR = 1.78; 95% CI, 1.15-2.76) to accept at least one test, according to the researchers. Meanwhile, patients in ZIP codes electing Republican Congress members were less likely to accept multiple tests vs. those in Democratic-leaning ZIP codes.
“Building infection surveillance capacity into routine dialysis care could potentially prevent a repeat catastrophe in the next pandemic,” researchers wrote. “This nationwide trial demonstrated that integrating infectious disease screening capacity into routine dialysis care is feasible and reaches high-risk persons, but its effectiveness, if still relevant from a public health perspective, will require additional approaches to improve patient participation.”
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