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Accuracy of 2 Rapid Antigen Tests During 3 Phases of SARS-CoV-2 Variants

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To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Are rapid antigen tests analytically and clinically accurate for detecting variants of SARS-CoV-2?

Findings  In this diagnostic study of 802 adults reporting COVID-19–like symptoms within the prior 5 days, no significant differences were found in the analytical limit of detection or clinical diagnostic accuracy of 2 rapid antigen tests across 3 epidemic phases of SARS-CoV-2 variants. The positive percent agreement ranged from 81% to 91% across the 3 phases of variants.

Meaning  This study found that 2 rapid antigen tests had consistent analytical and clinical accuracy across 3 phases of circulating SARS-CoV-2 variants.

Abstract

Importance  Variants of SARS-CoV-2 have sequence variations in the viral genome that may alter the accuracy of rapid diagnostic tests.

Objective  To assess the analytical and clinical accuracy of 2 rapid diagnostic tests for detecting SARS-CoV-2 during 3 phases of variants.

Design, Setting, and Participants  This diagnostic study included participants aged 18 years or older who reported onset of COVID-19–like symptoms within the prior 5 days and were tested at multiple COVID-19 testing locations in King County, Washington, from February 17, 2021, to January 11, 2022, during 3 distinct phases of SARS-CoV-2 infection (pre-Delta, Delta, and Omicron).

Interventions  Two anterior nasal swab specimens were collected from each participant—1 for onsite testing by the SCoV-2 Ag Detect Rapid Self-Test and 1 for reverse transcriptase–polymerase chain reaction (RT-PCR) testing.

Main Outcomes and Measures  The analytical limit of detection of the 2 rapid diagnostic tests (SCoV-2 Ag Detect Rapid Self-Test and BinaxNOW COVID-19 Ag Card) was assessed using Omicron (B.1.1.529/BA.1), Delta (B.1.617.2), and a wild-type (USA-WA1/2020) variant. Diagnostic sensitivity and specificity of clinical testing for the rapid antigen tests were compared with that of RT-PCR testing.

Results  A total of 802 participants were enrolled (mean [SD] age, 37.3 [13.3] years; 467 [58.2%] female), 424 (52.9%) of whom had not received COVID-19 vaccination and presented a median of 2 days (IQR, 1-3 days) from symptom onset. Overall, no significant differences were found in the analytical limit of detection or clinical diagnostic accuracy of rapid antigen testing across SARS-CoV-2 variants. The estimated limit of detection for both rapid nucleocapsid antigen tests was at or below a 50% tissue culture infectious dose of 62.5, and the positive percent agreement of the SCoV-2 Ag Detect Rapid Self-Test ranged from 81.2% (95% CI, 69.5%-89.9%) to 90.7% (95% CI, 77.9%-97.4%) across the 3 phases of variants. The diagnostic sensitivity increased for nasal swabs with a lower cycle threshold by RT-PCR, which correlates with a higher viral load.

Conclusions and Relevance  In this diagnostic study, analytical and clinical performance data demonstrated accuracy of 2 rapid antigen tests among adults with COVID-19 symptoms across 3 phases of SARS-CoV-2 variants. The findings suggest that home-based rapid antigen testing programs may be an important intervention to reduce global SARS-CoV-2 transmission.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: July 7, 2022.

Published: August 24, 2022. doi:10.1001/jamanetworkopen.2022.28143

Correction: This article was corrected on October 3, 2022, to fix Dr Hau’s academic degree in the byline.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Drain PK et al. JAMA Network Open.

Corresponding Author: Paul K. Drain, MD, MPH, University of Washington, 325 Ninth Ave, HMC# 359927, Seattle, WA 98104-2499 (pkdrain@uw.edu).

Author Contributions: Dr Drain had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Drain, Dalmat.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Drain, Dalmat, Uppal, Verma.

Critical revision of the manuscript for important intellectual content: Drain, Bemer, Morton, Dalmat, Abdille, Thomas, Hau, Green, Gates-Hollingworth, AuCoin, Verma.

Statistical analysis: Bemer, Dalmat, Thomas, Uppal.

Obtained funding: Drain, AuCoin.

Administrative, technical, or material support: Drain, Morton, Abdille, Hau, Green, Gates-Hollingworth.

Supervision: Drain, Morton, Abdille, Thomas, Hau, Gates-Hollingworth, AuCoin, Verma.

Conflict of Interest Disclosures: Dr Drain reported receiving grants from InBios International during the conduct of the study; research funding, paid to his institution, from the National Institutes of Health (NIH), the US Centers for Disease Control and Prevention (CDC), the Bill and Melinda Gates Foundation, Gilead Sciences, and Abbott; and consulting fees from Gilead Sciences, ThermoFisher, Cepheid, InBios International, Abbott, PATH, LumiraDx, and Alveo Technologies. Dr Uppal reported receiving financial support from InBioS LLC during the conduct of the study and outside the submitted work. Dr Hau reported receiving grants from the University of Nevada, Reno during the conduct of the study. Dr Gates-Hollingworth reported receiving grants from the University of Nevada, Reno during the conduct of the study. Dr AuCoin reported receiving fees from InBios International for a service contract to evaluate performance of the InBios SCoV-2 Ag Detect Rapid Self-Test during the conduct of the study; being the chief executive officer of a DxDiscovery Inc university startup pursuing development of a rapid diagnostic test for SARS-CoV-2; receiving grants from InBios International and the AuCoin laboratory; and having licensed technology from InBios International and the AuCoin laboratory for diagnosis of melioidosis outside the submitted work. No other disclosures were reported.

Funding/Support: The study was funded by InBios International Inc (Dr Drain).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Information: SARS-CoV-2 isolate USA-WA1/2020 was deposited by the CDC and obtained through BEI Resources, National Institute of Allergy and Infectious Diseases (NIAID), NIH: SARS-Related Coronavirus 2, NR-52281. The following reagents were obtained through BEI Resources, NIAID, NIH: SARS-Related Coronavirus 2, Isolate hCoV-19/USA/MD-HP05285/2021 (Lineage B.1.617.2; Delta Variant), and NR-55671, Isolate hCoV-19/USA/MD-HP20874/2021 (Lineage B.1.1.529; Omicron Variant), NR-56461, contributed by Andrew Pekosz, PhD (Johns Hopkins Bloomberg School of Public Health).

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