ArticleAmerican journal of preventive medicine2026
Does Home COVID-19 Testing Bias COVID-19 Vaccine Effectiveness Estimates?
Article in American journal of preventive medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionCOVID-19 home testing became widely available in early 2021. Care seeking for acute respiratory illness and COVID-19 vaccine effectiveness estimates may be affected by home testing.
methodsIn a test-negative case-control study, between January and May 2022, U.S. Flu VE Network outpatients were asked about their home COVID-19 testing before seeking care for acute respiratory illness and were laboratory tested for SARS-CoV-2. Associations among home testing, care seeking, and COVID-19 vaccine effectiveness were assessed using multivariable logistic regression.
resultsAmong 2,614 enrollees, home COVID-19 testing was significantly associated with current (≤6 months) COVID-19 vaccination (AOR=1.70; 95% CI=1.19, 2.42), cough (AOR=1.69; 95% CI=1.22, 2.34), and having a college degree or higher (AOR=1.67; 95% CI=1.37, 2.03) and was negatively associated with a prior positive COVID-19 test. COVID-19 illness was associated with cough (AOR=3.07; 95% CI=2.04, 4.61), contact with a COVID-19 case (AOR=2.41; 95% CI=1.93, 3.0), and home testing (AOR=1.87; 95% CI=1.53, 2.29) and was negatively associated with a prior positive COVID-19 test. In unadjusted modeling with only the association between current vaccination and COVID-19 infection, the OR was 0.78 (95% CI=0.66, 0.92). Adjusting for patient race/ethnicity, age, days from onset to enrollment, prior COVID-19 illness, and study site, the AOR was 0.65 (95% CI=0.55, 0.78). Estimated vaccine effectiveness was 35% (95% CI=22%, 45%). Adding home testing to this adjusted model, vaccine effectiveness was 37% (95% CI=13%, 46%). Among patients who home tested, vaccine effectiveness was 31% (95% CI=13%, 46%) versus 43% (95% CI=24%, 57%) among patients who did not.
conclusionsPatients reporting home testing for COVID-19 before seeking outpatient care for acute respiratory illness differed from patients not using home tests, which could affect estimates of COVID-19 vaccine effectiveness in some populations.
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