Understanding the acceptability of COVID-19 antigen rapid diagnostic tests: A multi-country qualitative study

Accessible and timely diagnostic testing was essential during the COVID-19 pandemic to control the virus’s spread and mitigate severe outcomes. However, real-time polymerase chain reaction tests, although sensitive incur high costs and prolonged turnaround times, and face implementation challenges in many resource-constrained settings. Antigen rapid diagnostic tests (Ag-RDT), which can be administered either by providers or as self-tests, are accessible and low-cost alternatives. We conducted this study to assess the acceptability of Ag-RDT in different use cases and delivery models in Malawi, Nigeria, and Zimbabwe. We implemented a qualitative study drawing on Louart’s theoretical framework for the acceptability of technological healthcare innovations. In-depth interviews (n = 228) were conducted with community members, healthcare workers and providers to explore participants’ experiences with Ag-RDT COVID-19 testing. Data were analysed using NVivo 14 software, applying an inductive thematic approach centred on the constant comparison method across countries, participant groups, and delivery models. The study revealed that Ag-RDT COVID-19 testing was acceptable across the three settings due to speed, non-invasiveness, and simplicity in sample collection compared to the real-time polymerase chain reaction alternative. Ag-RDT was integrated into existing healthcare systems with minimal disruption and used effectively across different use cases and populations. Participants particularly valued the self-testing option for its privacy, reduced stigma and convenience. However, acceptability was somewhat affected by the timing of the intervention, as it was implemented toward the end of the COVID-19 pandemic when many individuals no longer perceived testing as a priority.