The effect of proximity of COVID-19 test facilities on test uptake: two quasi-experimental trials

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Access to testing sites is a critical component in reducing the spread of a virus during infectious disease outbreaks. For example, distance to the testing site has been mentioned as an important self-reported barrier for test uptake during the COVID-19 pandemic. Despite its importance, there is still little experimental evidence on the effect of proximity of testing sites on test uptake in high income countries. In this study we test the effect of proximity of COVID-19 test facilities on test uptake in the Netherlands during a community wide testing initiative during the COVID-19 pandemic. We conducted two quasi-experimental studies in three villages in The Netherlands between February 8th and March 21st, 2021. In Study 1 ( n = 11,317) a testing site was placed in one village (reducing distance to testing site from 8.4 km to 800 m) but not in a comparable control village (distance to testing site 9.9 km). In Study 2 ( n = 1,880) a mobile test bus alternated between two areas codes in one village, changing the average distance to the testing site from 3.5 km (bus absent) to 200 m (bus present) and from 1.6 km (bus absent) to 850 m (bus present). Study 1 assessed the number of individuals who tested for COVID-19 and the number of times a unique individual tested (combined as the total number of tests conducted). Study 2 assessed the total number of tests conducted per week. In Study 1, a log linear regression controlling for baseline differences (8.6% control vs. 10% intervention) found that reducing the distance to the testing site significantly increased the percentage of tested residents (17.5% control vs. 29% intervention [OR = 1.84, 95% CI = 1.68–2.02]). In Study 2, a Poisson regression revealed higher test uptake when the mobile test bus was present (33.6% when absent vs. 42.6% when present [incidence rate ratio = 1.35, 95% CI = 1.15–1.59]). Reducing the distance to test facilities increased test uptake. Localising test facilities can substantially increase testing for COVID-19, and thus the effectiveness of a Test, Trace, and Isolate strategy in general. WHO International Clinical Trial Registry Platform ( NL9365 /NL-OMON26968).