Pooling samples to increase testing capacity with Xpert Xpress SARS-CoV-2 during the Covid-19 pandemic in Lao People's Democratic Republic.

Iem, Vibol, Xangsayarath, Phonepadith, Chittamany, Phonenaly, Suthepmany, Sakhone, Siphanthong, Souvimone, Paboriboune, Phimpha, Somphavong, Silaphet, Kontogianni, Konstantina, Khan, Jahangir A M, Edwards, Thomas, Wingfield, Tom ORCID: https://orcid.org/0000-0001-8433-6887, Creswell, Jacob, Dominguez, Jose and Cuevas, Luis ORCID: https://orcid.org/0000-0002-6581-0587 (2022) 'Pooling samples to increase testing capacity with Xpert Xpress SARS-CoV-2 during the Covid-19 pandemic in Lao People's Democratic Republic.'. PLoS ONE, Vol 17, Issue 9, e0275294.

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Abstract

The COVID-19 pandemic created the need for large-scale testing of populations. However, most laboratories do not have sufficient testing capacity for mass screening. We evaluated pooled testing of samples, as a strategy to increase testing capacity in Lao PDR. Samples of consecutive patients were tested in pools of four using the Xpert Xpress SARS CoV-2 assay. Positive pools were confirmed by individual testing, and we describe the performance of the test and savings achieved. We also diluted selected positive samples to describe its effect on the assays CT values. 1,568 patients were tested in 392 pools of four. 361 (92.1%) pools were negative and 31 (7.9%) positive. 29/31 (93.5% (95%CI 77-99%) positive pools were confirmed by individual testing of the samples but, in 2/31 (6.5%) the four individual samples were negative, suggesting contamination. Pools with only one positive sample had higher CT values (lower RNA concentrations) than the respective individual samples, indicating a dilution effect, which suggested an increased risk of false negative results with dilutions >1:10. However, this risk may be low if the prevalence of infection is high, when pools are more likely to contain more than one positive sample. Pooling saved 67% of cartridges and substantially increased testing capacity. Pooling samples increased SARS-CoV-2 testing capacity and resulted in considerable cartridge savings. Given the need for high-volume testing, countries may consider implementation of pooling for SARS-CoV-2 screening.

Item Type:	Article
Subjects:	WA Public Health > Preventive Medicine > WA 243 Diagnositic services WC Communicable Diseases > WC 20 Research (General) WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 506 COVID-19
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1371/journal.pone.0275294
Depositing User:	Julie Franco
Date Deposited:	12 Oct 2022 10:52
Last Modified:	04 Oct 2023 12:44
URI:	https://archive.lstmed.ac.uk/id/eprint/21303

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