Combining rapid antigen testing and syndromic surveillance improves community-based COVID-19 detection in a low-income country

Chadwick, F. J. et al. (2022) Combining rapid antigen testing and syndromic surveillance improves community-based COVID-19 detection in a low-income country. Nature Communications, 13, 2877. (doi: 10.1038/s41467-022-30640-w) (PMID:35618714) (PMCID:PMC9135686)

Abstract

Diagnostics for COVID-19 detection are limited in many settings. Syndromic surveillance is often the only means to identify cases but lacks specificity. Rapid antigen testing is inexpensive and easy-to-deploy but can lack sensitivity. We examine how combining these approaches can improve surveillance for guiding interventions in low-income communities in Dhaka, Bangladesh. Rapid-antigen-testing with PCR validation was performed on 1172 symptomatically-identified individuals in their homes. Statistical models were fitted to predict PCR-status using rapid-antigen-test results, syndromic data, and their combination. Under contrasting epidemiological scenarios, the models’ predictive and classification performance was evaluated. Models combining rapid-antigen-testing and syndromic data yielded equal-to-better performance to rapid-antigen-test-only models across all scenarios with their best performance in the epidemic growth scenario. These results show that drawing on complementary strengths across rapid diagnostics, improves COVID-19 detection, and reduces false-positive and -negative diagnoses to match local requirements; improvements achievable without additional expense, or changes for patients or practitioners.

• Item Type: Articles
• Additional Information: This work is supported by a grant from the Bill and Melinda Gates Foundation to FAO (INV-022851). FJC is funded by EPSRC (EP/R513222/1), DJP by the JUNIPER consortium (MR/V038613/1), and KH by Wellcome (207569/Z/17/Z).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Illian, Professor Janine and Chowdhury, Ms Tasnuva and Wilkie, Dr Craig and Clark, Dr Jessica and Chadwick, Fergus and Swallow, Dr Ben and Pascall, Dr David and Hill, Dr Davina and Kundegorski, Mikolaj and Husmeier, Professor Dirk and Hampson, Professor Katie and Matthiopoulos, Professor Jason and Mair, Professor Frances and Haddou, Mr Yacob
• Authors: Chadwick, F. J., Clark, J., Chowdhury, S., Chowdhury, T., Pascall, D. J., Haddou, Y., Andrecka, J., Kundegorski, M., Wilkie, C., Brum, E., Shirin, T., Alamgir, A.S.M., Rahman, M., Alam, A. N., Khan, F., Swallow, B., Mair, F. S., Illian, J., Trottter, C. L., Hill, D. L., Husmeier, D., Matthiopoulos, J., Hampson, K., and Sania, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Science and Engineering > School of Mathematics and Statistics > Statistics
• Journal Name: Nature Communications
• Publisher: Nature Research
• ISSN: 2041-1723
• ISSN (Online): 2041-1723
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Nature Communications 13: 2877
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
305200		DTP 2018-19 University of Glasgow	Mary Beth Kneafsey	Engineering and Physical Sciences Research Council (EPSRC)	EP/R513222/1	MVLS - Graduate School
301620		The Science of Rabies Elimination	Katie Hampson	Wellcome Trust (WELLCOTR)	207569/Z/17/Z	Institute of Biodiversity, Animal Health and Comparative Medicine