Feasibility and acceptability of COVID-19 self-testing offered through community screening posts in Mozambique: a mixed-methods study

Background COVID-19 self-testing is a key strategy for point-of-care testing and COVID-19 out- management to identify persons infected with SARS-CoV-2 in low- and middle-income settings. We assessed the feasibility and acceptability of healthcare worker-supervised COVID-19 self-tests at community bi-directional screening posts for COVID-19 and tuberculosis in urban and peri-urban areas in southern Mozambique. Methods Persons presenting with symptoms suggestive of COVID-19 and those at risk of COVID-19 infection were eligible for self-testing. We collected and described cascade of care data and survey data of persons who completed self-testing, and conducted logistic regression to assess predictors for the likelihood of using the self-test again (likely/not likely). We invited a subset of clients and supervising healthcare workers for semi-structured in-depth interviews, of which transcripts we analyzed using a thematic approach. Results We invited 382 persons for self-testing, of whom 369 (96.6%) clients performed self-test. 328 (88.9%) were willing to use the self-test again when experiencing COVID-19 symptoms, and 332 (90%) declared to accept its use as a screening measure for COVID-19 contacts. Provided its affordability, clients perceived self-testing as an acceptable strategy following its accessibility, comfortable usage, quick results. Feasibility of self-testing requires instructional videos in local languages and implementation should be done through community channels. All supervising healthcare workers perceived self-testing as an important tool for increasing testing accessibility, early diagnosis, reduction of overcrowding and COVID-19 infection risk in healthcare facilities. Conclusions COVID-19 self-testing is acceptable and feasible if provided with linguistic and cultural appropriate health education and instructions at affordable price. Self-test delivery packages and systems should be developed that could be adapted to existing or future self-tests for infectious diseases or other non-communicable diseases.