# Sociodemographic and Psychosocial Factors Influencing COVID-19 Testing Uptake: Insights from Urban and Rural Communities in South Africa

## TL;DR

This study examines factors affecting willingness to take a COVID-19 test in urban and rural South African communities.

## Contribution

The study identifies sociodemographic factors influencing testing uptake and highlights the need for targeted health campaigns.

## Key findings

- Females, older individuals, and vaccinated people were more likely to consent to testing.
- Those previously infected with SARS-CoV-2 were less likely to consent to testing.
- Older adults and urban populations showed lower willingness to undergo testing.

## Abstract

Access, demand, and acceptance of coronavirus disease 2019 (COVID-19) testing have varied globally. This study explored the sociodemographic and psychosocial risk factors that contribute to the uptake of COVID-19 testing in community settings in South Africa. This paper presents a cross-sectional secondary analysis using data from a cluster randomized controlled trial and a nested perception survey of COVID-19 antigen testing in communities located in urban (eThekwini, KwaZulu-Natal) and rural settings (Worcester, Eastern Cape) in South Africa. Individuals who were reluctant to get tested participated in the perception survey. Data were analyzed using descriptive statistics and multivariable logistic regression to assess linear associations and estimate adjusted odds ratios (ORs). The analysis was conducted on 3,074 individuals, of whom 2,509 (81.6%) provided consent for COVID-19 testing. Among those, 2,505 (81.5%) tested negative, and 4 (0.1%) tested positive for COVID-19. The mean age of participants was 38 (SD = 14.61), and 57% were male. Females (OR: 1.27; 95% CI = 1–1.6), individuals older than 56 years (OR: 1.95; 95% CI = 1.24–3.07), and those who were vaccinated (OR: 1.99; 95% CI = 1.53–2.60) were more likely to consent. Individuals who had previously tested positive for severe acute respiratory syndrome coronavirus 2 were less likely to consent to testing (OR: 0.64; 95% CI = 0.11–0.46). No link was found between depression, anxiety, substance use, and willingness to undergo COVID-19 testing. A perceptions survey involving 704 participants, which explored factors influencing testing willingness, found that older adults, and urban populations were less likely to undergo COVID-19 testing. Targeted health campaigns may improve testing rates. Larger-scale implementation research is required to explore best practices for improving testing rates and confidence in population-level detection within South Africa.