Community-Based SARS-CoV-2 Testing in Low-Income Neighbourhoods in Rotterdam: Results From a Multi-Methods Study

Background: High incidence of SARS-CoV-2 and low testing uptake were reported in low-income neighbourhoods in Rotterdam. We aimed to improve willingness and access to testing by introducing community-based test facilities and evaluated the effectiveness of rapid antigen detection tests (RDT).Methods: Two to eleven test facilities operated consecutively in three low-income neighbourhoods in Rotterdam, offering the option of walk-in or by-appointment. Background characteristics were collected at intake and one nasopharyngeal swab was taken and processed using both RDT and RT-PCR. Visitors were asked to join a survey for evaluation purposes.Findings: In total, 19,773 visitors were tested; 9,662 (48·9%) without appointment. Walk-in visitors were older, lived more often in the proximity of the test facilities, and less often reported COVID-related symptoms than visitors by-appointment. For 67·7% of the visitors, this was the first time they got tested. A total of 1,211 (6·1%) tested SARS-CoV-2-positive with RT-PCR, of whom 309 (25·5%) were asymptomatic. Test uptake increased among residents of the intervention neighbourhoods, especially in the older age groups, compared to people living in comparable neighbourhoods without community-based testing facilities. RDT detected asymptomatic individuals with 71·8% sensitivity, which was acceptable in this high prevalence setting. Visitors reported positive attitudes towards the test facilities and welcomed the easy access. Interpretation: Offering community-based SARS-CoV-2 testing using RDTs seems a promising approach for increasing testing uptake among specific populations in low-income neighbourhoods.Funding Information: This project was funded by the Dutch Ministry of Health, Welfare and Sport and by the H2020 RECOVER project (grant number 101003589). Declaration of Interests: None declared.Ethics Approval Statement: Ethical approval was not required since this study was performed as a public health intervention in an outbreak situation and as part of a response to a public health emergency. Testing was carried out for diagnostic purposes and the use of leftover material for assay validation is permitted under Dutch law.