The School SPIT Study - COVID-19 Testing in Secondary Schools

The School SPIT Study (Saliva to Promote Improved Testing): A Prospective Evaluation of a Home Saliva Testing Program for COVID-19 Implemented With a Stepped-wedge Cluster Randomized Design in Secondary Schools.

This study will conduct an evaluation of a program that is being implemented SickKids / Toronto Public health that provides take-home saliva testing kits in schools. Operationally, there is a planned randomization so that all schools have an equitable chance to receive the intervention at various time periods during the planned operational roll-out, which will require a staggered implementation consistent with the stepped-wedge study design. The study will leverage this chance implementation to do a robust evaluation of the public health intervention. Schools that are not being rolled out to week one, will begin in the "control phase" (testing at an assessment center) and transition to the program "intervention phase" (take home saliva kits available at schools) at a randomly assigned time (wedge) over a 6-week period with all schools receiving the program by the end of the study. The investigators will evaluate the impact of the program on SARS-CoV-2 case identification in schools.

This is a prospective evaluation of a program that is being implemented using a stepped-wedge, cluster randomized design. Eligible secondary public schools in Toronto Region will be randomized. The study will occur over a 7-week period with a minimum of one-week of baseline data (control phase - testing at an assessment center, primary care or acute care center) and then schools will start the program in a stepwise manner (10 crossovers per week) with take-home saliva being available to all 60 schools by the end of the study period. The primary objective of the study is to assess whether the availability of take home saliva kits at schools for symptomatic PCR testing leads to increased diagnosis of COVID-19 cases in the school.

This is a prospective evaluation of a program that is being implemented using a stepped-wedge, cluster randomized design.

Schools will start in the control phase (SARS-CoV-2 diagnostic testing at an assessment center, primary care office or acute care center) and transition to the intervention phase at a randomly assigned time point over the course of the study.

Schools will have take home saliva kits available at the school to support SARS-CoV-2 diagnostic testing. Schools will transition to the intervention phase at a randomly assigned time (wedge) over a 6-week period with all schools receiving the program by the end of the study.

Saliva kits will be made available at schools for pick up to support symptomatic testing using PCR for students, staff and family members.

The number of cases positive for SARS-CoV-2 in a cohort per week per school (rate per cohort per week) in the intervention period compared to the control period.

To assess whether availability of take-home saliva kits at school leads to earlier testing as measured by duration of symptoms before testing of the symptomatic case

To assess whether the availability of take-home saliva testing leads to reduced transmission within exposed cohorts as measured by the number of secondary cases identified in exposed cohorts.

Secondary schools will be included in the evaluation if they are: Considered a secondary school by the school board Open for in-person learning during the study period They have at least 100 students Offer Grades 9-12 (secondary) Exclusion Criteria: Schools that are middle schools only, that are not open for in-person learning, have fewer than 100 students or are not a complete secondary school (i.e. adult learning schools, schools offering independent courses, prep schools with 1-2 grades, secondary schools with < 4 grades) will be excluded.