RESUMEN
Background: Early diagnosis of COVID-19 is key to prevent severe cases and poor outcomes in vulnerable populations, including pregnant women and people living with HIV or infected with tuberculosis (TB). The feasibility of integration of SARS-CoV-2 antigen rapid diagnostic testing (Ag-RDT) into maternal neonatal, and child Health (MNCH);HIV;and TB clinics is unknown. Method(s): We analyzed data from a SARS-CoV-2 screen and test program implemented in 50 health facilities (25 in Kenya and 25 in Cameroon), integrating SARS-CoV-2 Ag-RDT in MNCH, HIV, and TB clinics between May and October 2022. Clients aged two and older attending MNCH, HIV, and TB clinics were offered SARS-CoV-2 screening, and those eligible were tested using SARS-CoV-2 Ag-RDT. Routine SARS-CoV-2 program data were captured through dedicated paper forms in Cameroon or an electronic medical record (EMR) interface in Kenya and transferred to a database for analysis. We estimated the proportion of clients screened and tested and the SARS-CoV-2 positivity rates. Result(s): Overall, 527,184 attendee visits were reported in Cameroon (282,404) and Kenya (244,780), with screening for COVID-19 symptoms and exposure performed in 256,033 (48.5%) with substantive variations between countries (62.6% in Cameroon and 32.4% in Kenya). Among the 256,033 screened, 19,058 (7.4%) were eligible for testing (9.0% in Cameroon and 3.9% in Kenya), of whom 12,925 (67.8%) were tested for SARS-CoV-2 with substantial variation in testing rates between countries (61.9% in Cameroon and 97.9% in Kenya) and clinics (59.9% in MNCH, 68.7% in HIV, and 92.8% in TB clinics). A total of 390 (3.0%) positive tests were identified (329 (3.3%) in Cameroon and 61 (2.0%) in Kenya). The estimated case detection rate was 1.26 (95% CI=0.76-1.75) per 1,000 attendee visits in Cameroon and 0.49 (95% CI=0.12-0.86) per 1,000 attendee visits in Kenya. Country integration strategy, facility level, setting, and clinic were independently associated with screening (Table 1) and testing. Conclusion(s): Integration of SARS-CoV-2 Ag-RDT in HIV, TB, and MNCH clinics was feasible in both countries despite challenges with low screening rates in Kenya and low testing rates in Cameroon. Decentralization of SARS-CoV-2 testing at different facility clinics allowed detection of SARS-CoV-2 cases among vulnerable populations. Integration strategies should consider facility settings (rural compared to urban) and additional human resources in high volume facilities to improve screening and testing rates.
RESUMEN
Background: In Africa, the 9.3 million COVID-19 cases and 174,993 related deaths reported between 2020 and 2022 are underestimated given the limited testing and reporting capacity. Mass testing with antigen-detecting rapid diagnostic tests (Ag-RDTs), including testing of asymptomatic individuals, is expected to improve the identification of SARS-CoV-2 infections and enable immediate clinical management, isolation of patients, contact tracing, and quarantining of contacts. We offered mass Ag-RDT testing in large gatherings to determine the SARS-CoV-2 case detection rate, acceptance of mass testing, the prevalence of circulating variants, and the cost of implementation. Method(s): In 49 high-attendance facilities in Kiambu County identified as possible points of community-based transmission, individuals two years old and older were offered COVID-19 testing and vaccination. Those accepting testing were enrolled in the study after providing written informed consent. A questionnaire was administered and a nasopharyngeal swab was collected. Those testing positive and those testing negative but with COVID-19 symptoms were referred for PCR testing and genome sequencing. Data were analyzed using descriptive statistics. The total cost of implementing the community testing was estimated from a health system perspective using a micro-costing method. Result(s): From June-September 2022, 4,062 individuals were offered testing (mean age 39 years, 2,114 (58.6%) were male). The testing acceptance was 78.1% (3,174/4,062) 95%CI, 76.9%-79.5%). The case detection rate was 34/3,174 (1.07%: 95%CI 0.7%-1.4%). Table 1 shows the testing and case detection rates by facility type. Of the 34 positive cases, 11 (32%) were asymptomatic. A PCR result was available for 27 Ag-RDT positive participants and 13 Ag-RDT negative participants with SARS-COV-2 symptoms and was positive in 24 (88.9%) and 4 (30.8%) respectively. Circulating variants were identified in 11 participants (Omicron 22A: 36% and 22B: 64%);15 samples could not be sequenced due to CT values >35. Community mobilization was the major cost driver (26%) followed by the purchase of SARS-CoV-2 Ag-RDT (20.5%). The total cost of the intervention was US$50,538;the cost per individual tested was US$15.89 and US$1,484 per new COVID-19. Conclusion(s): Targeted mass community testing using SARS-CoV-2 Ag-RDT is a feasible and affordable strategy in identifying priority areas for vaccination and early treatment for individuals with COVID-19.