Rapid antigen testing by community health workers for detection of SARS-CoV-2 in Dhaka, Bangladesh: a cross-sectional study

Sania, A. et al. (2022) Rapid antigen testing by community health workers for detection of SARS-CoV-2 in Dhaka, Bangladesh: a cross-sectional study. BMJ Open, 12(6), e060832. (doi: 10.1136/bmjopen-2022-060832) (PMID:35649599) (PMCID:PMC9160589)

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Objective: To evaluate the diagnostic performance and feasibility of rapid antigen testing for SARS-CoV-2 detection in low-income communities. Design: We conducted a cross-sectional community-based diagnostic accuracy study. Community health workers, who were trained and supervised by medical technicians, performed rapid antigen tests on symptomatic individuals, and up to two additional household members in their households and diagnostic results were calibrated against the gold standard RT-PCR. Setting: Low-income communities in Dhaka, Bangladesh. Participants: Between 19 May 2021 and 11 July 2021, 1240 nasal and saliva samples were collected from symptomatic individuals and 993 samples from additional household members (up to two from one household). Results: The sensitivity of rapid antigen tests was 0.68 on nasal samples (95% CI 0.62 to 0.73) and 0.41 on saliva (95% CI 0.35 to 0.46), with specificity also higher on nasal samples (0.98, 95% CI 0.97 to 0.99) than saliva (0.87, 95% CI 0.85 to 0.90). Testing up to two additional household members increased sensitivity to 0.71 on nasal samples (95% CI 0.65 to 0.76), but reduced specificity (0.96, 95% CI 0.94 to 0.97). Sensitivity on saliva rose to 0.48 (95% CI 0.42 to 0.54) with two additional household members tested but remained lower than sensitivity on nasal samples. During the study period, testing in these low-income communities increased fourfold through the mobilisation of community health workers for sample collection. Conclusions: Rapid antigen testing on nasal swabs can be effectively performed by community health workers yielding equivalent sensitivity and specificity to the literature. Household testing by community health workers in low-resource settings is an inexpensive approach that can increase testing capacity, accessibility and the effectiveness of control measures through immediately actionable results.

Item Type:Articles
Additional Information:The Bill and Melinda Gates Foundation (BMGF) funded work by FAO (INV-022851) and UoG reports funding from Wellcome (207569/Z/17/Z to KH).
Glasgow Author(s) Enlighten ID:Chowdhury, Ms Tasnuva and Kundegorski, Mikolaj and Hill, Dr Davina and Chadwick, Fergus and Hampson, Professor Katie
Authors: Sania, A., Alam, A. N., Alamgir, A.S.M., Andrecka, J., Brum, E., Chadwick, F., Chowdhury, T., Hasan, M.D. Z., Hill, D. L., Khan, F., Kundegorski, M. E., Lee, S., Rahman, M., Rayport, Y. K., Shirin, T., Tasneem, M., and Hampson, K.
College/School:College of Medical Veterinary and Life Sciences
College of Science and Engineering
College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN (Online):2044-6055
Published Online:01 June 2022
Copyright Holders:Copyright © Author(s) (or their employer(s)) 2022
First Published:First published in BMJ Open 12(6):e060832
Publisher Policy:Reproduced under a Creative Commons Licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
301620The Science of Rabies EliminationKatie HampsonWellcome Trust (WELLCOTR)207569/Z/17/ZInstitute of Biodiversity, Animal Health and Comparative Medicine