Open Collections

Kayda, Iryna

University of British Columbia

Background: Challenges arose with diagnostic testing during the coronavirus disease 2019 (COVID-19) pandemic. Gargle sampling emerged as a novel method for COVID-19 testing, yet there remains uncertainty about its performance when compared with more conventional sampling methods. Objective: We investigated the performance of self-collected gargle samples compared to traditional healthcare worker (HCW)-collected upper respiratory tract swabs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection with nucleic acid amplification testing (NAAT). We aimed to (1) estimate sensitivity of gargle sampling, (2) estimate the difference in sensitivity between gargle and swab methods, and (3) understand how various testing contexts may impact gargle sensitivity. Methods: MEDLINE, EMBASE, Web of Science, Global Index Medicus, and preprint servers were searched. Studies reporting primary data and investigating COVID-19 diagnostic performance of self-collected gargle samples compared to a HCW-collected swab, with at least five matched samples tested using NAAT, were included. Random effects meta-analysis was conducted to estimate both the pooled gargle sensitivity and mean difference in sensitivity between gargle and swab methods. Subgroup analyses were also performed to assess the potential impact of different sampling variables. Results: Searches identified 327 results with 24 studies included in the review. 28 gargle-swab comparisons were pooled in meta-analysis. Gargle sensitivity was estimated to be 92.7% (95% confidence interval: 89.9% to 94.8%) and 3.2% (0.4% to 6.0%) less sensitive than swab collection. Gargle sensitivity was greater than 87.0% across diverse patient characteristics, settings, type or volume of gargle liquid, length of gargling time, wait time prior to gargling, and reference swab type or NAAT method used. Greatest sensitivities were observed when gargle sampling for 30 seconds or greater using 5-9 mL of saline. 92.9% (86.9% to 96.2%) gargle sensitivity was observed when there was no required wait time, and sensitivity was 90.4% (87.0% to 93.0%), even when compared to high quality combined nasopharyngeal and oropharyngeal (NPOP) swabs. Conclusion: Gargle sampling is a sensitive, non-inferior method for SARS-CoV-2 detection across various testing contexts. Implementation of gargle sampling has potential to significantly reduce barriers associated with HCW-collected swabs and would facilitate testing and genomic surveillance for SARS-CoV-2 across diverse settings.

Text

2023-10-26

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/86344

Experimental Medicine

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/