889. Effectiveness of Implementing Take-Home Kits for Specimen Collection in a Clinical Trial
Session: Poster Abstract Session: Clinical Trials
Friday, October 9, 2015
Room: Poster Hall
Posters
  • Los_THKs_poster2.pdf (2.7 MB)
  • Background: Acute respiratory illness (ARI) is a common problem among healthcare personnel (HCP) that results in transmission and lost work time. In a national cluster-randomized clinical trial, ARI among HCP was assessed through combined nasal and throat swab collection.  However, if HCP felt too ill to attend work, we risked missing useful specimens. We implemented a take-home kit (THK) approach for HCP to collect and mail their own swabs.

    Methods:   HCP were surveyed for symptoms of ARI for 12 weeks during 4 influenza seasons (2011-5). While 2 random swabs per participant were obtained by research assistants (RAs) during the intervention period, we also attempted to capture data for ARI amongst HCP. If HCP were at work and available, the RAs obtained the swabs directly; if HCP stayed home sick or had scheduling conflicts, the HCP were then asked to follow printed directions in a THK to obtain and mail their own samples (all materials provided in the kits).  Swabs were frozen at -800C, aliquoted and tested for 13 viruses by RT-PCR/ESI-MS, (Abbott Molecular). We calculated the incremental cost-effectiveness ratio (ICER) by dividing the cost difference between collection methods by the difference in viral detection rates.

    Results:   Among 4947 participants, 3095 symptomatic swabs were obtained.  To-date, 1876 samples have been tested and in 558 (30%) a pathogen was identified.  Of the 282 THK samples, a respiratory virus was detected in 37.6% while 28.4% of those obtained by RAs had a virus identified (p = 0.1628). Influenza, a main focus for the parent study, was much more prevalent in THKs and coronavirus more common to RA-obtained samples (Figure 1). For each additional $0.67 per swab, we would observe a 1% improvement in our ability to detect ARI using THKs (Figure 2).

    Conclusion:   The use of THKs is a reliable and cost-effective method to obtain otherwise missed samples. For many of the pathogens detected, we would actually save money while improving ARI detection, while only 2 would be cost-prohibitive (adenovirus, RSV).  Crucial to the parent study, influenza would require a minimal additional investment in THKs to improve our virus captures.  The severe symptoms and fever typical of influenza cause HCP to miss work, which may account for more positives among THK swabs.

    Jenna Los, MLA, Medicine, Johns Hopkins University, Baltimore, MD, Mary Bessesen, MD, University of Colorado Denver, Aurora, CO, Alexandria C Brown, PhD, University of Massachusets Amherst, Amherst, MA, Derek Cummings, PhD, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, Charlotte Gaydos, DrPH, FIDSA, Medicine, Infectious Diseases, Johns Hopkins University, Baltimore, MD, Cynthia Gibert, MD, MSc, FIDSA, Washington, DC, VAMC, Washington, DC, Geoffrey Gorse, MD, FIDSA, VA St. Louis Healthcare System, St. Louis, MO, Jeffrey Holden, MA, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, Ann-Christine Nyquist, MD, MSPH, FPIDS, University of Colorado, Denver, CO, Connie S. Price, MD, Department of Medicine, Division of Infectious Diseases, Denver Health Medical Center, Denver, CO, Lewis J. Radonovich, MD, VA NY Harbor Healthcare System, New York, NY, Nicholas G Reich, PhD, Biostatistics, Johns Hopkins University, Baltimore, MD, Maria C. Rodriguez-Barradas, MD, FIDSA, Infectious Diseases, Michael E. DeBakey VA Medical Center, Houston, TX, Michael S. Simberkoff, MD, FIDSA, VA New York Harbor Healthcare System, New York, NY, Trish M. Perl, MD, MSc, FIDSA, FSHEA, Medicine, Johns Hopkins Medical Institutions, Baltimore, MD and The ResPECT Study Team

    Disclosures:

    J. Los, None

    M. Bessesen, None

    A. C. Brown, None

    D. Cummings, None

    C. Gaydos, Abbott/Ibis: Grant Investigator , Research support

    C. Gibert, None

    G. Gorse, None

    J. Holden, None

    A. C. Nyquist, None

    C. S. Price, None

    L. J. Radonovich, None

    N. G. Reich, None

    M. C. Rodriguez-Barradas, None

    M. S. Simberkoff, None

    T. M. Perl, None

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