INTEGRATION OF SARS-CoV-2 RAPID ANTIGEN TEST IN HEALTH SERVICES IN KENYA AND CAMEROON

ABSTRACT

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.