Low uptake of COVID-19 lateral flow testing among university students: a mixed methods evaluation

French, C. E.; Denford, S.; Brooks-Pollock, E.; Wehling, H.; Hickman, M.

Background: University populations offer a unique opportunity to quantify COVID-19 lateral flow testing (LFT) uptake. Methods: Mixed methods evaluation of LFT among University of Bristol students comprising an analysis of testing uptake using logistic regression analyses; a survey; and qualitative interviews to explore experiences of testing and subsequent behaviour. Results: 12,391 LFTs were conducted on 8025/36,054 (22.3%) students. Only one in 10 students had the recommended two tests. There were striking demographic disparities in uptake with those from ethnic minority groups having lower uptake (e.g. 3% of Chinese students were tested vs. 30.7% of White students), and variations by level and year of study (ranging from 5.3% to 33.7%), place of residence (29.0% to 35.6%) and faculty (15.2% to 32.8%). Barriers to engagement with testing included a lack of awareness, knowledge and understanding, and concerns about the accuracy and safety. Students understood limitations of LFTs but requested further information about test accuracy. Tests were used to inform behavioural decisions, often in combination with other information, such as the potential for exposure to the virus and perceptions of vulnerability. Conclusions: The low uptake of testing brings into question the role of mass LFT in university settings.