{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T23:48:00Z","timestamp":1778197680693,"version":"3.51.4"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2024,10,4]],"date-time":"2024-10-04T00:00:00Z","timestamp":1728000000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009131","name":"Swiss Agency for Development and Cooperation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009131","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Places of worship serve as a venue for both mass and routine gathering around the world, and therefore are associated with risk of large-scale SARS-CoV-2 transmission. However, such routine gatherings also offer an opportunity to distribute self-tests to members of the community to potentially help mitigate transmission and reduce broader community spread of SARS-CoV-2. Over the past four years, self-testing strategies have been an impactful tool for countries\u2019 response to the COVID-19 pandemic, especially early on to mitigate the spread when vaccination and treatment options were limited. We used an agent-based mathematical model to estimate the impact of various strategies of symptomatic and asymptomatic self-testing for a fixed percentage of weekly routine gatherings at places of worship on community transmission of SARS-CoV-2 in Brazil, Georgia, and Zambia. Testing strategies assessed included weekly and bi-weekly self-testing across varying levels of vaccine effectiveness, vaccine coverage, and reproductive numbers to simulate developing stages of the COVID-19 pandemic. Self-testing symptomatic people attending routine gatherings can cost-effectively reduce the spread of SARS-CoV-2 within places of worship and the community, resulting in incremental cost-effectiveness ratios of $69-$303 USD. This trend is especially true in contexts where population level attendance at such gatherings is high, demonstrating that a distribution approach is more impactful when a greater proportion of the population is reached. Asymptomatic self-testing of attendees at 100% of places of worship in a country results in the greatest percent of infections averted and is consistently cost-effective but remains costly. Budgetary needs for asymptomatic testing are expensive and likely unaffordable for lower-middle income countries (520-1550x greater than that of symptomatic testing alone), promoting that strategies to strengthen symptomatic testing should remain a higher priority.<\/jats:p>","DOI":"10.1371\/journal.pone.0311198","type":"journal-article","created":{"date-parts":[[2024,10,4]],"date-time":"2024-10-04T17:24:42Z","timestamp":1728062682000},"page":"e0311198","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost-effectiveness of SARS-CoV-2 self-testing at routine gatherings to minimize community-level infections in lower-middle income countries: A mathematical modeling study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0003-7179","authenticated-orcid":true,"given":"Megan A.","family":"Hansen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvin X.","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua M.","family":"Chevalier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan","family":"Klock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiromi","family":"Pandithakoralage","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra de","family":"Nooy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Ockhuisen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah J.","family":"Girdwood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nkgomeleng A.","family":"Lekodeba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaukat","family":"Khan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen E.","family":"Jenkins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheryl C.","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jilian A.","family":"Sacks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin A.","family":"Russell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4682-4999","authenticated-orcid":true,"given":"Brooke E.","family":"Nichols","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,10,4]]},"reference":[{"key":"pone.0311198.ref001","unstructured":"Statement on the fifteenth meeting of the IHR (2005) Emergency Committee on the COVID-19 pandemic [Internet]. [cited 2024 Jun 28]. Available from: https:\/\/www.who.int\/news\/item\/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic"},{"key":"pone.0311198.ref002","unstructured":"COVID-19 cases | WHO COVID-19 dashboard [Internet]. [cited 2024 Jun 28]. Available from: https:\/\/data.who.int\/dashboards\/covid19\/cases"},{"key":"pone.0311198.ref003","unstructured":"FIND COVID-19 Test tracker [Internet]. [cited 2024 Jun 28]. Available from: https:\/\/www.finddx.org\/tools-and-resources\/dxconnect\/test-directories\/covid-19-test-tracker\/"},{"key":"pone.0311198.ref004","unstructured":"WHO issues its first emergency use listing for a SARS-CoV-2 self-test | WHO\u2014Prequalification of Medical Products (IVDs, Medicines, Vaccines and Immunization Devices, Vector Control) [Internet]. [cited 2024 Jun 28]. Available from: https:\/\/extranet.who.int\/prequal\/news\/who-issues-its-first-emergency-use-listing-sars-cov-2-self-test"},{"issue":"Suppl 4","key":"pone.0311198.ref005","doi-asserted-by":"crossref","first-page":"e005598","DOI":"10.1136\/bmjgh-2021-005598","article-title":"The cost effectiveness and optimal configuration of HIV self-test distribution in South Africa: a model analysis","volume":"6","author":"L Jamieson","year":"2021","journal-title":"BMJ Global Health"},{"key":"pone.0311198.ref006","article-title":"Cost-effectiveness of hepatitis C virus self-testing. In: Recommendations and guidance on hepatitis C virus self-testing","author":"JG Walker","year":"2021","journal-title":"World Health Organization"},{"key":"pone.0311198.ref007","unstructured":"Key planning recommendations for mass gatherings in the context of COVID-19 [Internet]. [cited 2024 Jun 28]. Available from: https:\/\/www.who.int\/publications\/i\/item\/10665-332235"},{"key":"pone.0311198.ref008","doi-asserted-by":"crossref","first-page":"100215","DOI":"10.1016\/j.mran.2022.100215","article-title":"Assessment of COVID-19 risk and prevention effectiveness among spectators of mass gathering events","volume":"21","author":"T Yasutaka","year":"2022","journal-title":"Microbial Risk Analysis"},{"issue":"10","key":"pone.0311198.ref009","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1016\/S1473-3099(21)00268-1","article-title":"Same-day SARS-CoV-2 antigen test screening in an indoor mass-gathering live music event: a randomised controlled trial","volume":"21","author":"B Revollo","year":"2021","journal-title":"The Lancet Infectious Diseases"},{"issue":"10","key":"pone.0311198.ref010","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.7326\/M21-2976","article-title":"To Test or Not to Test: COVID-19 Prevention Strategies to Keep Large Gatherings Safe","volume":"174","author":"CD Estelle","year":"2021","journal-title":"Ann Intern Med"},{"issue":"4","key":"pone.0311198.ref011","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s40475-020-00218-x","article-title":"Hajj and Umrah Mass Gatherings and COVID-19","volume":"7","author":"VT Hoang","year":"2020","journal-title":"Infection. 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Available from: https:\/\/www.zamstats.gov.zm\/"},{"key":"pone.0311198.ref016","unstructured":"Brazilian Institute of Geography and Statistics, IBGE\u2013Censo 2010 [Internet]. [cited 2024 Jul 16]. Available from: https:\/\/censo2010.ibge.gov.br\/"},{"key":"pone.0311198.ref017","unstructured":"National Statistics Office of Georgia\u2013Census, 2014 \u2013\u10db\u10d7\u10d0\u10d5\u10d0\u10e0\u10d8 [Internet]. [cited 2024 Jul 17]. Available from: https:\/\/www.geostat.ge\/en"},{"key":"pone.0311198.ref018","unstructured":"The Age Gap in Religion Around the World [Internet]. Pew Research Center. 2018 [cited 2024 Jul 16]. Available from: https:\/\/www.pewresearch.org\/religion\/2018\/06\/13\/the-age-gap-in-religion-around-the-world\/"},{"key":"pone.0311198.ref019","unstructured":"NDI time-series dataset Georgia [Internet]. Caucas Research Resource Center. 2020 [cited 2024 Jul 16]. Available from: https:\/\/www.caucasusbarometer.org\/en\/ndi-ge\/RELSERV\/"},{"key":"pone.0311198.ref020","unstructured":"Report on International Religious Freedom: Zambia [Internet]. United States Department of State. [cited 2024 Jul 16]. Available from: https:\/\/www.state.gov\/reports\/2020-report-on-international-religious-freedom\/zambia\/"},{"key":"pone.0311198.ref021","unstructured":"Support Package including US $7 million investment accelerates availability of affordable COVID-19 self-tests in low- and middle-income countries [Internet]. FIND. [cited 2024 Jul 16]. Available from: https:\/\/www.finddx.org\/publications-and-statements\/support-package-including-us7-million-investment-accelerates-availability-of-affordable-covid-19-self-tests-in-low-and-middle-income-countries\/"},{"issue":"4","key":"pone.0311198.ref022","doi-asserted-by":"crossref","first-page":"e078852","DOI":"10.1136\/bmjopen-2023-078852","article-title":"Cost of SARS-CoV-2 self-test distribution programmes by different modalities: a micro-costing study in five countries (Brazil, Georgia, Malaysia, Ethiopia and the Philippines)","volume":"14","author":"MA Hansen","year":"2024","journal-title":"BMJ Open"},{"issue":"Suppl 4","key":"pone.0311198.ref023","doi-asserted-by":"crossref","first-page":"e005191","DOI":"10.1136\/bmjgh-2021-005191","article-title":"Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa","volume":"6","author":"LA Sande","year":"2021","journal-title":"Zambia and Zimbabwe. 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Available from: https:\/\/www.healthdata.org\/research-analysis\/diseases-injuries\/covid\/policy-briefings"},{"key":"pone.0311198.ref027","unstructured":"COVID-19 Results Briefing: Zambia [Internet]. Institute for Health Metrics and Evaluation, IHME. [cited October 13, 2022]. 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