A rapid review of equity considerations in large-scale testing campaigns during infectious disease epidemics

  1. Katarina Ost
  2. Louise Duquesne
  3. Claudia Duguay
  4. Lola Traverson
  5. Isadora Mathevet
  6. Valéry Ridde
  7. Kate Zinszer

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Abstract

Context

Large-scale testing is an intervention that is instrumental for infectious disease control and a central tool for the COVID-19 pandemic. Our rapid review aimed to identify if and how equity has been considered in large-scale testing initiatives.

Methods

We searched Web of Science and PubMed in November 2020 and followed PRISMA recommendations for scoping reviews. Articles were analyzed using descriptive and thematic analysis.

Results

Our search resulted in 291 studies of which 41 were included for data extraction after full article screening. Most of the included articles (83%) reported on HIV-related screening programs, while the remaining programs focused on other sexually transmitted infections (n=3) or COVID-19 (n=4). None of the studies presented a formal definition of (in)equity in testing, however, 23 articles did indirectly include elements of equity in the program or intervention design, largely through the justification of their target population.

Conclusion

The studies included in our rapid review did not explicitly consider equity in their design or evaluation. It is imperative that equity is incorporated into the design of infectious disease testing programs and serves as an important reminder of how equity considerations are needed for SARS-CoV-2 testing and vaccination programs.

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  1. Version published to 10.1101/2021.02.22.21252205v2 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2021.02.22.21252205: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationThe MMAT encompasses five study design categories: i) qualitative research, ii) randomized controlled trials, iii) non-randomized studies, iv) quantitative descriptive studies, and v) mixed methods studies.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We began our electronic database query in July 2020 on PubMed and Web of Science, and updated our search in November 2020 to better reflect the rapidly evolving state of COVID-19 literature.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    The inclusion criteria for articles were: i) a focus on an infectious disease, ii) description of the design portion of a testing or screening program, iii) published in English or in French, iv) had an empirical degree greater than 80 according to the ATCER tool, and v) published after 2010. 2.2 Selection of studies: All identified studies were imported from PubMed and Web of Science into Rayyan QCRI (26), a systematic review software, for screening of the titles, abstracts, and full texts.
    ATCER
    suggested: None
    The PROGRESS Plus framework was developed and endorsed by the Campbell and Cochrane Equity Methods Group, in order to highlight a set of social determinants of health that drive variations in health outcomes and the inequalities among the social determinants of health gradient (28).
    Cochrane Equity
    suggested: None
    In addition, we followed the Template for Intervention Description and Replication
    Replication
    suggested: (Replication Domain, RRID:SCR_012941)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    4.1 Limitations: Given our objective to include studies with empirical results and also to conduct the review in a timely manner, we chose an ATCER threshold of 80. This may have limited our findings and the generalizability of the results. We recommend that a full scoping review be conducted on this topic to further investigate important trends on the incorporation of health equity into infectious disease testing programs. 4.2 Conclusion: The results of this rapid review highlight the overall lack of consideration of equity in the design of large-scale testing interventions. This is a particularly concerning issue as social and economic inequities continue to be exacerbated by COVID-19 and there has not been any research to date that discusses how COVID-19 testing programs have been designed with equity in mind (1–3). To achieve equity in testing and to optimize the role of testing in disease prevention and control, strategies should ensure that the probability of being tested is proportionate to the risk of being affected by the disease (85,86). We urge practitioners, decision makers, and researchers to explicitly include equity measures when designing and implementing COVID-19 large-scale testing interventions, which should also be considered in COVID-19 vaccination programs.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.02.22.21252205v1 on medRxiv