A remote household-based approach to influenza self-testing and antiviral treatment.

Abstract

BACKGROUND:

Households represent important settings for transmission of influenza and other respiratory viruses. Current influenza diagnosis and treatment relies upon patient visits to healthcare facilities, which may lead to under-diagnosis and treatment delays. This study aimed to assess the feasibility of an at-home approach to influenza diagnosis and treatment via home testing, telehealth care, and rapid antiviral home delivery.

METHODS:

We conducted a pilot interventional study of remote influenza diagnosis and treatment in Seattle-area households with children during the 2019-2020 influenza season using pre-positioned nasal swabs and home influenza tests. Home monitoring for respiratory symptoms occurred weekly; if symptoms were reported within 48 hours of onset, participants collected mid-nasal swabs and used a rapid home-based influenza immunoassay. An additional home-collected swab was returned to a laboratory for confirmatory influenza RT-PCR testing. Baloxavir antiviral treatment was prescribed and delivered to symptomatic and age-eligible participants, following a telehealth encounter.

RESULTS:

124 households comprising 481 individuals self-monitored for respiratory symptoms, with 58 home tests administered. 12 home tests were positive for influenza, of which eight were true positives confirmed by RT-PCR. The sensitivity and specificity of the home influenza test were 72.7% and 96.2%, respectively. There were eight home deliveries of baloxavir, with 7 (87.5%) occurring within 3 hours of prescription and all within 48 hours of symptom onset.

CONCLUSIONS:

We demonstrate the feasibility of self-testing combined with rapid home delivery of influenza antiviral treatment. This approach may be an important control strategy for influenza epidemics and pandemics.

• Authors: Jessica Heimonen, Denise J McCulloch, Jessica O'Hanlon, Ashley E Kim, Anne Emanuels, Naomi Wilcox, Elisabeth Brandstetter, Mark Stewart, David McCune, Scott Fry, Sean Parsons, James P Hughes, Michael L Jackson, Timothy M Uyeki, Michael Boeckh, Lea M Starita, Trevor Bedford, Janet A Englund, Helen Y Chu
• Journal: Influenza and other respiratory viruses (Influenza Other Respir Viruses) Vol. 15 Issue 4 Pg. 469-477 (07 2021) ISSN: 1750-2659 [Electronic] England
• PMID: 33939275 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.

Chemical References

• Antiviral Agents

Topics

• Antiviral Agents (therapeutic use)
• Child
• Humans
• Influenza, Human (diagnosis, drug therapy, epidemiology)
• Pandemics
• Self-Testing
• Sensitivity and Specificity