Performance of and preference for saliva sampling for detection of SARS-COV-2 in the Bahamas

Implementing public health diagnostic modalities that are simultaneously accurate and acceptable is integral to effective pandemic response. In this regard, saliva has proven to be a reliable alternative to nasopharyngeal swabs (NPS) for the detection of SARS-COV-2 infections. In particular, the SalivaDirect protocol utilises untreated saliva as its sample type, and removes the need for RNA extraction, thereby decreasing the time and cost of diagnosis by RT-PCR. IN the current study we piloted SalivaDirect in the context of The Bahamas archipelago, where it demonstrated acceptable performance, with 95.2% concordance with NPS. However, there was discordance in 3 of the 8 total SARS-COV-2 positive samples,all of which were above Ct 30 and therefore presumably of low infectivity. Furthermore, a significant majority of survey respondents chose saliva as their preferred sample type and this was associated with citing ‘discomfort’ of NPS sampling as the reason for their choice. These results support the practical use of SalivaDirect in the Bahamas as a mass testing tool.