The REACT-2 programme

This laboratory study evaluated the performance of finger-prick antibody tests in NHS staff who previously had COVID-19 and in 500 pre-pandemic samples from key workers, and selected the best test to use in the main study.

Publications
Flower B, Brown JC, Simmons B, et al Clinical and laboratory evaluation of SARS-CoV-2 lateral flow assays for use in a national COVID-19 seroprevalence survey Thorax 2020;75:1082-1088.

Moshe M, Daunt A, Flower B, et al. SARS-CoV-2 lateral flow assays for possible use in national covid-19 seroprevalence surveys (React 2): diagnostic accuracy study BMJ 2021; 372 :n423 doi:10.1136/bmj.n423

SARS-CoV-2 Antibody Lateral Flow Assay for antibody prevalence studies following vaccine roll out: a Diagnostic Accuracy Study (Preprint) https://doi.org/10.1101/2021.07.14.21260488

Christina J Atchison, Maya Moshe, Jonathan C Brown, Matthew Whitaker, Nathan C K Wong, Anil A Bharath, Rachel A McKendry, Ara Darzi, Deborah Ashby, Christl A Donnelly, Steven Riley, Paul Elliott, Wendy S Barclay, Graham S Cooke, Helen Ward, Validity of Self-testing at Home With Rapid Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibody Detection by Lateral Flow Immunoassay, Clinical Infectious Diseases, 2022 https://doi.org/10.1093/cid/ciac629

This tested the acceptability and usability of home-based antibody testing with 300 public volunteers. They were invited to identify any issues and concerns with carrying out finger-prick antibody tests at home, and worked with us to improve the design of the kits and instructions for the larger studies.

An expanded study then further explored the usability of home-based antibody testing. Tests were sent to 14,000 randomly selected members of the public to explore whether they can perform the finger-prick test at home and read the results correctly as well as identify any issues in delivering to a large group of people.

A further study looked at whether home antibody testing led to people changing their behaviour.

Publications
Atchison C, Pristerà P, Cooper E, et al. Usability and Acceptability of Home-based Self-testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibodies for Population Surveillance. Clin Infect Dis. 2021;72(9):e384-e393. doi:10.1093/cid/ciaa1178

Redd R, Cooper E, Atchison C et al. Behavioural responses to SARS-CoV-2 antibody testing in England: REACT-2 study. Wellcome Open Res 2021, 6:203

This study compared the accuracy and acceptability of tests in non-healthcare key workers (employed by the police and fire service), and measured the prevalence of infection.

Publications
Davies B, Araghi M, Moshe M, et al. Acceptability, Usability, and Performance of Lateral Flow Immunoassay Tests for Severe Acute Respiratory Syndrome Coronavirus 2 Antibodies: REACT-2 Study of Self-Testing in Nonhealthcare Key Workers. Open Forum Infect Dis. 2021;8(11):ofab496.

As part of the REACT-2 programme, during the COVID-19 pandemic, antibody test kits, for use at home, were used to estimate how many people had COVID antibodies. These estimations indicated how many people had been exposed to the virus or had antibodies due to vaccination. However, some positive test results can be very faint, and be mistaken as negative. In our work, 500,000 people reported their antibody test results and submitted a photograph of their test. We designed a computerised system—a highly specialised artificial-intelligence (AI) system—that had high agreement with experts and could highlight potential mistakes by the public in reading the results of their home tests. This AI system makes it possible to improve the accuracy of monitoring COVID antibodies at the population level (e.g. whole country), which could inform decisions on public health, such as when booster vaccines should be administered.

Publications

Access the full report here: REACT ALFA Pipeline Full Technical Report.

Nathan C. K. Wong, Sepehr Meshkinfamfard, Valérian Turbé, Matthew Whitaker, Maya Moshe, Alessia Bardanzellu, Tianhong Dai, Eduardo Pignatelli, Wendy Barclay, Ara Darzi, Paul Elliott, Helen Ward, Reiko J. Tanaka, Graham S. Cooke, Rachel A. McKendry, Christina J. Atchison & Anil A. Bharath Machine learning to support visual auditing of home-based lateral flow immunoassay self-test results for SARS-CoV-2 antibodies Commun Med 2, 78 (2022).
https://doi.org/10.1038/s43856-022-00146-z