ArticlePLOS global public health2026
Acceptability of COVID-19 self-testing among social and clinical vulnerable populations using a decentralized testing model in Abuja, Nigeria; A mixed methods analysis of an implementation study.
Article in PLOS global public health, 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
Diagnostic testing is critical during infectious disease outbreaks, enabling timely patient management and isolation to reduce transmission and mortality. During the COVID-19 outbreak in Nigeria, testing rates remained low due to limited access to centralized RT-PCR sites. To expand access, the National COVID-19 Testing Strategy (January 2021) introduced decentralized self-testing models targeting vulnerable populations. This study assessed the uptake of decentralized COVID-19 testing and the acceptability of self-testing among socially and clinically vulnerable populations in Abuja, Nigeria. A mixed-methods study was conducted across four primary health centres (PHC), four community pharmacies (CP), and four patent medicine stores (PMS) between October 2022 and May 2023. Symptomatic individuals received provider-delivered testing at PHC or provider-delivered/self-testing at CP and PMS using antigen rapid diagnostic tests (Ag-RDT). Social vulnerability was defined by low education, illiteracy, or low wealth; clinical vulnerability by age ≥ 50, unvaccinated status, or comorbidities. Testing uptake and acceptability were analyzed using logistic regression, while in-depth interviews (IDI) explored preferences for testing sites and methods. Of 1,586 individuals screened, 1,368 were eligible and 1,322 (96.6%) accepted testing. Most tests occurred at PHC (53.5%), followed by PMS (25.9%) and CP (20.7%). Social vulnerability was higher among PMS users than PHC users (OR = 1.37; 95% CI 1.05-1.77), while clinical vulnerability was lower at CP (OR = 0.24; 95% CI 0.16-0.35) and PMS (OR = 0.28; 95% CI 0.19-0.39) compared to PHC. Self-testing acceptability was high (93.4% at CP; 92.1% at PMS). Outcome of IDI highlighted trust in CP/PMS providers, proximity, convenience, and affordability as key drivers of testing uptake, with self-testing widely preferred across vulnerability groups. Decentralized testing through CP and PMS reached more socially vulnerable individuals and demonstrated high self-testing acceptability. Leveraging these outlets in outbreak responses could enhance equitable access to diagnostic testing in future pandemics.
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