{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T22:58:38Z","timestamp":1785797918447,"version":"3.56.0"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100032626","name":"Unitaid","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100032626","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>\n                    Rapid diagnostic self-tests have emerged as effective tools for identifying and controlling the spread of SARS-CoV-2. However, little is known about their acceptability and usability among populations under socioeconomic vulnerability globally. We aimed to evaluate the acceptability and usability of a COVID-19 antigen self-test among persons living in Salvador and Rio de Janeiro, Brazil. In this cross-sectional study (January\u2013May 2023), participants used a COVID-19 antigen self-test in a simulated real-world setting, guided by an instructional video. Usability was assessed through two main outcomes: comprehension of instructions and proper execution of self-test (Poisson regression model); and accuracy in interpretation of self-test results (Cohen\u2019s kappa). Acceptability was evaluated based on willingness to reuse the self-test, user experience, and recommendation to others. Among 437 participants, most were women (65.7%), self-identified as Black\/\n                    <jats:italic>Pardo (mixed-race)<\/jats:italic>\n                    (81.5%), aged 35\u2009+\u2009years (65.7%), had a household income\u2009\u2264\u2009USD 470 (70.0%) and had completed secondary education (46.2%). Despite some procedural difficulties, most participants obtained valid results (88.1%), higher in Salvador (95.2%) than in Rio de Janeiro (81.7%) (p\u2009&lt;\u20090.001). Participants showed difficulty interpreting test results, particularly inconclusive with a positive mark (32.9% correct) and faint positive markers (25.2% correct). Accuracy in interpretation was 89.6%, with moderate to substantial inter-rater agreement (Cohen\u2019s kappa\u2009=\u20090.56 overall, reaching 0.78 among participants aged 35\u201344 years). Participants with older age, lower education level and self-identified as men had lower likelihood of obtaining valid results in adjusted model, and increased difficulties in test setup and interpretation. Over 95% of participants were willing to reuse and recommended the self-test. This study revealed high acceptability and usability of the COVID-19 antigen self-test among populations under socioeconomic vulnerability in Brazil. However, misinterpretation poses public and individual health risks, underscoring the need of simplified, multimodal and accessible instructions.\n                  <\/jats:p>","DOI":"10.1371\/journal.pgph.0005678","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T18:49:12Z","timestamp":1770317352000},"page":"e0005678","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Acceptability and usability of COVID-19 antigen self-test in populations under socioeconomic vulnerability in Brazil: A cross-sectional study"],"prefix":"10.1371","volume":"6","author":[{"given":"D\u00e9bora","family":"Castanheira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laio","family":"Magno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thais Aranha","family":"Rossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6267-245X","authenticated-orcid":true,"given":"Suelen","family":"Seixas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiane","family":"Soares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Novaes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Dourado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valdilea G.","family":"Veloso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2557-601X","authenticated-orcid":true,"given":"Thiago S.","family":"Torres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"issue":"1","key":"pgph.0005678.ref001","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1089\/heq.2023.0020","article-title":"A Call to Improve Usability, Accuracy, and Equity of Self-Testing for COVID-19 and Other Rapid Diagnostic Tests","volume":"7","author":"PK Drain","year":"2023","journal-title":"Health Equity"},{"key":"pgph.0005678.ref002","doi-asserted-by":"crossref","DOI":"10.1097\/QMH.0000000000000396","article-title":"Testing the Acceptability and Usability of an AI-Enabled COVID-19 Diagnostic Tool Among Diverse Adult Populations in the United States","volume":"32","author":"J Schilling","year":"2023","journal-title":"Qual Manag Health Care"},{"issue":"2","key":"pgph.0005678.ref003","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1177\/193229681300700225","article-title":"Self-Monitoring of Blood Glucose in Type 2 Diabetes: Recent Studies","volume":"7","author":"O Schnell","year":"2013","journal-title":"J Diabetes Sci Technol"},{"key":"pgph.0005678.ref004","doi-asserted-by":"crossref","first-page":"101","DOI":"10.2174\/1874613601711010101","article-title":"Acceptability and Usability Evaluation of Finger-Stick Whole Blood HIV Self-Test as An HIV Screening Tool Adapted to The General Public in The Central African Republic","volume":"11","author":"G Gr\u00e9senguet","year":"2017","journal-title":"Open AIDS J"},{"issue":"6","key":"pgph.0005678.ref005","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(18)30044-4","article-title":"Reliability of HIV rapid diagnostic tests for self-testing compared with testing by health-care workers: a systematic review and meta-analysis","volume":"5","author":"C Figueroa","year":"2018","journal-title":"Lancet HIV"},{"issue":"1","key":"pgph.0005678.ref006","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1186\/s12879-022-07706-7","article-title":"Self-testing for SARS-CoV-2 in S\u00e3o Paulo, Brazil: results of a population-based values and attitudes survey","volume":"22","author":"GZ Mart\u00ednez-P\u00e9rez","year":"2022","journal-title":"BMC Infect Dis"},{"issue":"9","key":"pgph.0005678.ref007","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.3390\/diagnostics11091685","article-title":"Knowledge, Attitudes, and Behavior Related to COVID-19 Testing: A Rapid Scoping Review","volume":"11","author":"I Bevan","year":"2021","journal-title":"Diagnostics"},{"key":"pgph.0005678.ref008","unstructured":"World Health Organization. Interim guidance - Use of SARS-CoV-2 antigen-detection rapid diagnostic tests for COVID-19 self-testing [Internet]. WHO; 2022 [cited 2024 Apr 29]. Available from: https:\/\/iris.who.int\/bitstream\/handle\/10665\/352350\/WHO-2019-nCoV-Ag-RDTs-Self-testing-2022.1-eng.pdf?sequence=1"},{"issue":"3","key":"pgph.0005678.ref009","doi-asserted-by":"crossref","DOI":"10.1128\/Spectrum.01008-21","article-title":"Implementation and Accuracy of BinaxNOW Rapid Antigen COVID-19 Test in Asymptomatic and Symptomatic Populations in a High-Volume Self-Referred Testing Site","volume":"9","author":"ZK Siddiqui","year":"2021","journal-title":"Microbiol Spectr"},{"issue":"7","key":"pgph.0005678.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0289291","article-title":"COVID-19 self-testing using antigen rapid diagnostic tests: Feasibility evaluation among health-care workers and general population in Malawi","volume":"18","author":"M Mukoka","year":"2023","journal-title":"PLoS One"},{"issue":"8","key":"pgph.0005678.ref011","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.26931","article-title":"Validation of an at-home direct antigen rapid test for COVID-19","volume":"4","author":"A Harmon","year":"2021","journal-title":"JAMA Network Open"},{"key":"pgph.0005678.ref012","unstructured":"Abbott. 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Available from: https:\/\/www.abbottbrasil.com.br\/corpnewsroom\/noticias\/press-releases\/panbio-COVID-19-autoteste.html"},{"key":"pgph.0005678.ref013","first-page":"100338","article-title":"Prevalence and predictors of anti-SARS-CoV-2 serology in a highly vulnerable population of Rio de Janeiro: A population-based serosurvey","volume":"15","author":"LE Coelho","year":"2022","journal-title":"Lancet Reg Health Am"},{"issue":"1","key":"pgph.0005678.ref014","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"JR Landis","year":"1977","journal-title":"Biometrics"},{"issue":"6","key":"pgph.0005678.ref015","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-068016","article-title":"Expansion of testing, isolation, quarantine, e-health and telemonitoring strategies in socioeconomically vulnerable neighbourhoods at primary healthcare in the fight against COVID-19 in Brazil: a study protocol of a multisite testing intervention using a mixed method approach","volume":"13","author":"L Magno","year":"2023","journal-title":"BMJ Open"},{"issue":"9","key":"pgph.0005678.ref016","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciaa1178","article-title":"Usability and acceptability of home-based self-testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies for population surveillance","volume":"72","author":"C Atchison","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"12","key":"pgph.0005678.ref017","doi-asserted-by":"crossref","first-page":"6686","DOI":"10.1002\/jmv.27249","article-title":"Evaluation of a SARS-CoV-2 antigen-detecting rapid diagnostic test as a self-test: Diagnostic performance and usability","volume":"93","author":"NG Cassuto","year":"2021","journal-title":"J Med Virol"},{"issue":"11","key":"pgph.0005678.ref018","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofab496","article-title":"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","volume":"8","author":"B Davies","year":"2021","journal-title":"Open Forum Infect Dis"},{"issue":"4","key":"pgph.0005678.ref019","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1111\/ppe.12874","article-title":"The validity of self-reported SARS-CoV-2 results among postpartum respondents","volume":"36","author":"K McCarthy","year":"2022","journal-title":"Paediatr Perinat Epidemiol"},{"issue":"3","key":"pgph.0005678.ref020","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1056\/NEJMcp2117115","article-title":"Rapid Diagnostic Testing for SARS-CoV-2","volume":"386","author":"PK Drain","year":"2022","journal-title":"New England J Med"},{"issue":"2","key":"pgph.0005678.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002336","article-title":"Self-tests for COVID-19: What is the evidence? A living systematic review and meta-analysis (2020\u20132023)","volume":"4","author":"A Anand","year":"2024","journal-title":"PLOS Glob Public Health"},{"issue":"1","key":"pgph.0005678.ref022","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0227198","article-title":"Usability assessment of seven HIV self-test devices conducted with lay-users in Johannesburg, South Africa","volume":"15","author":"M Majam","year":"2020","journal-title":"PLoS One"},{"key":"pgph.0005678.ref023","article-title":"COVID-19 self-testing in Brazil and the imminent risk of underreporting cases","volume":"56","author":"LAR Oliveira","year":"2023","journal-title":"Rev Soc Bras Med Trop"},{"issue":"4","key":"pgph.0005678.ref024","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.bjid.2020.05.004","article-title":"Telemedicine as a tool for PrEP delivery during the COVID-19 pandemic in a large HIV prevention service in Rio de Janeiro-Brazil","volume":"24","author":"B Hoagland","year":"2020","journal-title":"Braz J Infect Dis"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005678","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T18:49:19Z","timestamp":1770317359000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005678"}},"subtitle":[],"editor":[{"given":"Julia","family":"Robinson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,5]]},"references-count":24,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005678","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,5]]}}}