FDA Discusses First Authorized Home Collection Kit

Interpretation and Validation of Antibody Tests, and False Negative Test Results

April 30, 2020

On April 22, 2020, the FDA held its fourth town hall-style meeting where the in vitro diagnostics (IVD) community was invited to ask clarifying questions about the guidance on IVD testing released on March 16, 2020, allowing emergency use authorization (EUA) for qualifying diagnostic tests for SARS-CoV-2.

The key takeaways from the April 22, 2020 town hall meeting are listed below:

  • The first home collection kit was authorized via EUA. It is authorized for use only with the LabCorp COVID-19 RT-PCR test. Several other applications for authorization have been submitted, but the FDA is interested in seeing data showing that the samples can be accurately obtained by laypersons before considering authorization.

  • The interagency effort to test the accuracy of serological tests for COVID-19 has begun and a number of kits have been received. The FDA plans to offer manufacturers who surpass a certain threshold in testing accuracy a streamlined approach to EUA. Test kit developers interested in participating in this validation project should send an email to CDRH-OIR-POPS fda.hhs.gov. Additional information is available on the FDA FAQ website.

  • The FDA also discussed the positive predictive value of testing when the prevalence of the disease is low. For example, even for tests with a high accuracy (95% sensitivity and 99% specificity), the positive predicative value is only 49% when the disease prevalence is 1%. Thus, a positive test result in this scenario would only be correct 49% of the time. A second positive test result from the same patient greatly increases the positive predictive value. The FDA emphasized that since we do not yet know the COVID-19 disease prevalence, test results must be interpreted by a healthcare provider in the context of the patient’s clinical history and test accuracy.

  • An updated Instruction for Use (IFU) was published to clarify that only the direct swab approach should be used for a popular COVID-19 testing kit that was formerly used in conjunction with viral transport media (VTM). Labs wanting to validate testing not conducted at the point of care but hindered by the direct swab only instruction can contrive samples by pipetting known positive samples onto swabs with replicates for validation testing.

 

More information:

Use the MedWatch system to report any suspected issues with COVID-19 IVD tests, found here: https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program

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