Feasibility and acceptability of COVID-19 self-testing offered through community screening posts in Mozambique: a mixed-methods study

COVID-19 self-testing is a key strategy for point-of-care testing and COVID-19 outbreak management to identify people infected with SARS-CoV-2 in low- and middle-income settings. We assessed the feasibility and acceptability of healthcare worker-supervised COVID-19 self-tests at community bi-directional screening posts for COVID-19 and tuberculosis in urban and peri-urban areas in southern Mozambique. Between May and August 2023, Persons presenting with symptoms suggestive of COVID-19 and those at risk of COVID-19 infection were eligible for self-testing. We collected and described a cascade of care and survey data from people who completed self-testing and conducted logistic regression to assess predictors of the likelihood of using the self-test again (likely/not likely). We invited a subset of clients and supervising healthcare workers to semi-structured in-depth interviews, and we analysed their transcripts using a thematic approach. We invited 382 people for self-testing, of whom 369 (96.6%) clients performed the self-test. 328 (88.9%) were willing to use the self-test again when experiencing COVID-19 symptoms, and 332 (90%) declared to accept its use as a screening measure for COVID-19 contacts. Regarding its affordability, clients perceived self-testing as an acceptable strategy following its accessibility, comfort of use, and quick results. The feasibility of self-testing requires instructional videos in local languages, and implementation should be done through community channels. All supervising healthcare workers perceived self-testing as an important tool for increasing testing accessibility, early diagnosis, reduction of overcrowding and COVID-19 infection risk in healthcare facilities. COVID-19 self-testing is acceptable and feasible if provided with linguistically and culturally appropriate health education and instructions at an affordable price. Self-test delivery packages and systems should be developed that could be adapted to existing or future self-tests for infectious diseases or other non-communicable diseases.