Memorandum: COVID-19: Home Testing for Veterans

Memorandum “COVID-19: Home Testing for Veterans” link:

020922 –COVID-19 Home Testing for Veterans

1. Home antigen and nucleic-acid amplification (NAAT) self-tests for COVID-19 have been authorized by the Federal Drug Administration (FDA) and are available to the general public through existing public and private avenues of distribution. Veterans Health Administration (VHA) clinicians will encounter situations in which Veterans perform home self-tests, guidance is needed regarding circumstances under which proctored, or unproctored Veteran home self-test results may be accepted.  This memorandum provides guidance for home self-test performed by Veterans.
2. Testing should be performed in accordance with the FDA Emergency Use Authorization instructions. The decreasing order of preference for confidence in self-testing technique is listed below:
   1. The test is performed under direct observation (proctored), e.g., during a VA Video Connect (VVC) telehealth visit.
   2. The test is not performed under direct observation (unproctored), but an image of the test result is made available to the provider, e.g., by secure messaging or during a VVC telehealth visit.
   3. The test is unproctored and an image is not available, but the result is verbally reported to the provider.
3. COVID-19 home tests are generally adequate to:
   1. Provide an initial screening for Veterans with symptoms suggestive of COVID-19 or high-risk exposures in the community. A positive test under these circumstances is generally reliable, while a negative test does not exclude infection and should be confirmed with Polymerase Chain Reaction (PCR).
   2. Guide infection control precautions, including isolation and quarantine decisions in the community following the Centers for Disease Control and Prevention (CDC) guidelines.
   3. Assist Veterans in decisions regarding travel and attendance to community social events.
   4. Attendance to school or work under “test-to-stay” protocols as endorsed by CDC.
4. COVID-19 home tests are generally not appropriate for:
   1. Pre-procedural screening (although a positiveantigen home test may be sufficient cause to postpone an elective procedure while confirmation is pursued).
   2. Pre-admission screening.
5. Clinical discretion is needed in the interpretation of COVID-19 home tests when prescribing COVID-19 therapeutics for patients with barriers to access to a VA medical center. Factors taken into consideration include the confidence in testing technique, the clinical scenario (pretest probability), and the benefit/risk tradeoff of the clinical decision being made.
   1. If possible, a home test used for purposes of clinical decision-making should be confirmed with a test in a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory (ideally within VA, but a non-VA CLIA-certified laboratory-based test is an alternative).
   2. In Veterans who are symptomatic and perform a home self-test, a positive result may be accepted for authorizing EUA therapy if it meets conditions for use for the therapy described by VHA Pharmacy Benefits Management (PBM), available on the PBM SharePoint EUA folder.
6. Accepted home self-test results should be documented using the VA COVID-19 OUTSIDE TEST RESULTS template, selecting the result and method, selecting the “Patient self-reports” option, and specifying “Home” as the location, in congruence with current guidance. This action will affect the CPRS COVID-19 banner.
7. Further updates to this guidance will be provided in future versions of the VHA COVID Testing Guidebook.
8. For questions concerning this memorandum or employee testing guidelines, please contact: vhacovidtestingguidanceworkgroup@va.gov