Background: In winter 2022, SIREN, a prospective healthcare worker cohort study monitoring SARS-CoV-2, ran a pilot sub-study introducing multiplex PCR testing for SARS-CoV-2, influenza, and RSV to investigate winter pressures. Three pathways were trialled: (A) on-site (at hospital) swabbing for PCR testing, using the local laboratory for testing, (B) on-site swabbing using a UKHSA-commissioned laboratory for testing, and (C) postal swabbing using a UKHSA-commissioned laboratory for testing. Here, we compare pathways in relation to recruitment, testing coverage, participant acceptability, and UKHSA SIREN research team feedback.
Methods: A mixed methods evaluation using metrics of quality assurance and study fidelity (participant recruitment and retention; multiplex PCR testing timing and coverage), an adapted NIHR 'participant in research' feedback questionnaire, and thematic analysis of a UKHSA SIREN research team workshop.
Results: With 7,774 participants recruited, target recruitment (N = 7,500) was achieved. Thirty-nine sites took part in the sub-study (4,289 participants). Thirty-three used pathway A (3,713 participants), and six used pathway B (576 participants). 3,485 participants were enrolled into pathway C (27.8% of invitees). The median number of tests per participant was similar across pathways (6; 4; 5). However, sites using local laboratories showed a wide variation in the date they switched to multiplex testing (28th November 2022-16th March 2023). Consequently, influenza and RSV testing coverage was higher for pathways using UKHSA-commissioned laboratories (100.0% vs 45.6% at local laboratories). 1,204/7,774 (15.5%) participants completed the feedback survey. All pathways were acceptable to participants; 98.9% of postal and 97.5% of site-based participants 'would consider taking part again'.
Conclusion: Transitioning SARS-CoV-2 PCR testing to include influenza and RSV was challenging to achieve rapidly across multiple sites. The postal testing pathway proved more agile, and UKHSA-commissioned laboratory testing provided more comprehensive data collection than local laboratory testing. This sub-study indicates that postal protocols are effective, adaptable at pace, and acceptable to participants.
Copyright: © 2025 Russell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.