Safe and Healthy Schools

Not Applicable

Completed

Conditions: COVID-19
Sars-CoV-2 Infection

Interventions: Diagnostic Test: BinaxNOW Test
Diagnostic Test: "Lollipop" swab

Registration Number: NCT05105789

Lead Sponsor: University of Wisconsin, Madison

Brief Summary: This study will target Madison Metropolitan School District (MMSD) school children ages 4-19 and staff who have not had a previous positive COVID-19 test within the past 3 months. It will enroll children and adults for 1-3 days to explore whether serial "at-home" BinaxNOW testing is feasible and non-inferior to "at school" single PCR testing for the evaluation of symptomatic individuals with a negative initial BinaxNOW. It will also explore whether lollipop swabs are more acceptable and perform as well as nasal swabs with polymerase chain reaction (PCR) testing.

Detailed Description: Study Design: This is a quantitative community-based study, conducted in the K-12 setting with school children 4-19 years old, teachers, and staff.

If a participant's initial at-school BinaxNOW test is positive, then they will only complete the lollipop swab for PCR testing. They will NOT do the at-home BinaxNOW test.

If a participant's initial at-school BinaxNOW test is negative, then they will complete both the lollipop swab for PCR testing AND an at-home BinaxNOW test approximately 24 hours later.

If the participant is unwilling or unable to complete the at-home test, they will be presented with a lollipop swab only option.

Aim 1: The investigators will test the hypothesis that serial at-home BinaxNOW testing will be feasible and non-inferior to the single at-school PCR testing program. To do this, the investigators will distribute over-the-counter BinaxNOW antigen tests to volunteer families, and create a protocol to ensure families can perform and report test results accurately to the school.

Two key questions will be addressed:

1. Is 'at-home' BinaxNOW testing feasible for families?

2. Is serial 'at-home' BinaxNOW testing non-inferior to 'at-school' single PCR testing?

Aim 2: The investigators will test the hypothesis that lollipop swabs are more acceptable to individuals and PCR testing is non-inferior to performing PCR on nasal swabs. To test this hypothesis, the investigators will work with MMSD schools to incorporate a lollipop swab for PCR at the time a symptomatic student or staff receives a nasal swab for PCR that is part of the Department of Health Services (DHS) program.

Two key questions will be addressed:

1. Are lollipop swabs more acceptable to individuals when compared to nasal swabs?

2. Will lollipop swabs perform as well as nasal swabs with PCR-based testing?

Hypotheses to be tested:

* Aim 1.1: "At-home" BinaxNOW testing will be feasible for families.

* Aim 1.2: Serial "at-home" BinaxNOW testing is non-inferior to "at school" single PCR testing.

* Aim 2.1: Lollipop swabs are more acceptable to individuals than nasal swabs.

* Aim 2.2: Lollipop swabs will perform as well as nasal swabs with PCR-based testing.

Protocol Amendment 2/4/22 to expand the upper eligible age for children from 14 to 19 years and to recognize the potential supply chain limitations of BinaxNOW tests. If the study team does not have any BinaxNOW tests due to a supply shortage, the BinaxNOW procedures will be dropped and only the lollipop swab will be collected.

Protocol Amendment 5/16/22 extends the study timeline and adds a lollipop swab only option.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 100

Inclusion Criteria

school children ages 4-19
MMSD staff
have at least one symptom of COVID-19
have not had a positive COVID-19 test in the past 3 months
will undergo nasal PCR testing at an MMSD elementary school

Exclusion Criteria

received a positive COVID-19 test in the past 3 months

Criteria for inclusion in the final study sample:

Aim 1. Symptomatic participants with a negative at-school BinaxNOW test and nasal PCR results who complete both the lollipop PCR and at-home BinaxNOW tests within 72 hours will be included in the final study sample.
Aim 2. Symptomatic participants who provide a lollipop swab that is successfully resulted.

Criteria for exclusion in the final study sample:

Aim 1
- Missing nasal PCR result
- Do not successfully complete an at-home BinaxNOW test within 72 hours of the at-school BinaxNOW test
Aim 2
- Missing nasal PCR result
- Missing lollipop PCR result

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
BinaxNOW Test + Lollipop PCR	BinaxNOW Test	If a symptomatic participant's initial at-school BinaxNOW test was positive, then their study participation is complete after providing the lollipop swab for PCR testing. If a symptomatic participant's initial at-school BinaxNOW test was negative, then they will be asked to complete an at-home BinaxNOW test approximately 24 hours later. For the at-home BinaxNOW testing, the participant will schedule a follow-up virtual visit with the study coordinator. If they are unable to complete a virtual visit, they will schedule an in-person home visit. They will also be sent home with a BinaxNOW testing kit.
BinaxNOW Test + Lollipop PCR	"Lollipop" swab	If a symptomatic participant's initial at-school BinaxNOW test was positive, then their study participation is complete after providing the lollipop swab for PCR testing. If a symptomatic participant's initial at-school BinaxNOW test was negative, then they will be asked to complete an at-home BinaxNOW test approximately 24 hours later. For the at-home BinaxNOW testing, the participant will schedule a follow-up virtual visit with the study coordinator. If they are unable to complete a virtual visit, they will schedule an in-person home visit. They will also be sent home with a BinaxNOW testing kit.

Primary Outcome Measures

Name	Time	Method
Standard Diagnostic Test Outcomes for BinaxNOW at Home Testing as Compared to Nasal Swab PCR	up to 2 days	The primary diagnostic outcome measure will be the negative predictive value (NPV). The kappa values for sensitivity, specificity, positive predictive value (PPV) and NPV of the BinaxNOW at Home testing with respect to PCR nasal swab (gold standard) are reported here.
Frequency Table of Gold-Standard Nasal Swab PCR vs Lollipop Swab PCR COVID-19 Test Results	up to 2 days	Counts of negative and positive Nasal Swab vs. Lollipop Swab PCR COVID-19 tests with kappa statistical value.
Number of Successfully Completed At-home Tests	up to 24 hours	Feasibility of 'at-home' BinaxNOW testing will be determined by number of successfully completed at-home tests. At-home test taking will be monitored by study team remotely (via zoom or similar).
Standard Diagnostic Test Outcomes for Lollipop Swab PCR Testing as Compared to Nasal Swab PCR	up to 2 days	The kappa values for sensitivity, specificity, positive predictive value (PPV) and NPV of the Lollipop Swab PCR with respect to PCR nasal swab (gold standard) are reported here.
Percent of Participants Who Answer 'Yes' When Asked if Lollipop Swabs Are More Acceptable Than Nasal Swabs	up to 1 day	To address the acceptability of lollipop swabs vs nasal swabs, the study team will ask participants a binary question: Are lollipop swabs more acceptable to participants when compared to nasal swabs? Yes/No.