The School SPIT study (Saliva to Promote Improved Testing): A Stepped-wedge Cluster Randomized Controlled Trial of Take-home Saliva to Promote Symptomatic Testing

In-person schooling is important for the overall health and wellbeing of children and youth and as a result, enhanced health and safety measures have been put into place in schools to support their return. Of critical importance is the ability to identify cases so that contacts can be identified, appropriately isolated and tested to prevent further transmission. Unfortunately, public health investigations continue to identify students who attended school while symptomatic, so we know that children may not always seek testing, preventing contact tracing from occurring. This may be related to the fact that children can have mild symptoms, may not seek testing due to concerns about the tolerance of testing using a nasopharyngeal swab, and/or parents may have challenges with accessing a testing center. Therefore, reducing barriers to testing by providing take-home saliva kits through the school is likely to improve testing uptake and increase case identification, leading to earlier contact tracing and reduced transmission. In the proposed study, we will evaluate whether the availability of take-home saliva testing kits at schools to improves SARS-CoV-2 case identification. Elementary and high schools situated in both lower incidence regions (west Toronto) and higher incidence regions (Scarborough) will be included and will transition from standard of care (testing at an assessment center) to the intervention (additional availability of take-home saliva kits at school) each week for a duration of 6 weeks. We will compare the rate of case detection in the control period to the intervention period. Active and early diagnosis of individuals with COVID-19 is critical role in reducing transmission. This study will provide important information on whether the availability of a take-home saliva kit for symptomatic students improves equity of access, testing uptake and case identification in schools, which may also be applicable to other congregate settings.