Article Category:
Research Article

Optimizing the Use of Severe Acute Respiratory Syndrome Coronavirus 2 Antigen Rapid Diagnostic Tests for the Timely Detection of and Response to COVID-19 in Schools and Markets in Uganda

Jerry Mulondo Infectious Diseases Research Collaboration, Kampala, Uganda;

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Susan Nayiga Infectious Diseases Research Collaboration, Kampala, Uganda;

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Winnie Nuwagaba Infectious Diseases Research Collaboration, Kampala, Uganda;

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Patience Nayebare Infectious Diseases Research Collaboration, Kampala, Uganda;

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Jane Frances Namuganga Infectious Diseases Research Collaboration, Kampala, Uganda;

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Isaac Ssewanyana Infectious Diseases Research Collaboration, Kampala, Uganda;

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Moses R. Kamya Infectious Diseases Research Collaboration, Kampala, Uganda;
Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

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Joaniter I. Nankabirwa Infectious Diseases Research Collaboration, Kampala, Uganda;
Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

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DOI:
https://doi.org/10.4269/ajtmh.23-0758
Volume/Issue:
Ahead of Print
Open access
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The early detection and management of infections is crucial to control epidemics. We evaluated the feasibility and utility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen rapid diagnostic tests (Ag-RDTs) for the timely detection of and response to coronavirus disease 2019 in high-risk border communities in Uganda. Between May and September 2022, monthly cross-sectional surveys were conducted in 11 schools and two markets in two border districts. Only baseline and end-line testing were also performed in matched control communities. Antigen rapid diagnostic test results and demographic and clinical data were collected, and contacts of patients were traced and tested. All patients were advised to self-isolate, and compliance was assessed on day 5. We enrolled 10,406 participants out of 10,472 screened individuals. The participants had a 1.3% test positivity rate, with schools recording higher, but non-significant, positivity rates than markets (1.4% versus 0.9%; P = 0.149). We tracked 556 contacts, and 536 (96.4%) agreed to test. The test positivity rate was significantly higher among contacts than the index participants (8.8% versus 1.3%; P <0.001). Only 55 (29.7%) of the index participants self-isolated effectively. Settings that received monthly testing had lower end-line positivity rates than controls (0.3% versus 1.4%; P = 0.001). Repeated SARS-CoV-2 Ag-RDT testing is feasible and could reduce SARS-CoV-2 infections. However, the participation in testing may have been enhanced by the compensation provided. Also, isolation was limited, which may reduce the impact of the intervention when rolled out on a large scale. Innovative strategies to increase the isolation of patients could improve the utility of early testing for transmission reduction during epidemics.

Author Notes

Financial support: Funding for the study was provided by FIND (an international organization promoting diagnostic development and access in low-and middle-income countries, based in Geneva, Switzerland), through a grant FIND received from the German Federal Ministry for Economic Cooperation and Development (BMZ; FIND; CV22-0028). J. I. Nankabirwa is supported by the Fogarty International Center (Emerging Global Leader Award grant number K43TW010365). P. Nayebare and J. F. Namuganga are supported by the Fogarty International Center of the NIH under Award Number D43TW010526. The funders had no role in the study’s analyses and did not influence any study findings.

Current contact information: Jerry Mulondo, Susan Nayiga, Winnie Nuwagaba, Patience Nayebare, and Jane Frances Namuganga, Infectious Diseases Research Collaboration, Kampala, Uganda, E-mails: jmulondo@idrc-uganda.org, snaiga@idrc-uganda.org, winuwagaba@gmail.com, pnayebare@ymail.com, and jnamuganga@idrc-uganda.org. Isaac Ssewanyana, Infectious Diseases Research Collaboration, Kampala, Uganda, and Central Public Health Laboratories/UNHLS, Butabika, Uganda. E-mail: sewyisaac@yahoo.co.uk. Moses R. Kamya and Joaniter I. Nankabirwa, Infectious Diseases Research Collaboration, Kampala, Uganda, and Makerere University College of Health Sciences, Kampala, Uganda, E-mails: mkamya@idrc-uganda.org and jnankabirwa@yahoo.co.uk.

Address correspondence to Jerry Mulondo, Infectious Diseases Research Collaboration, Plot 2C Nakasero Hill Rd., Kampala, Uganda. E-mail: jmulondo@idrc-uganda.org
Copyright:
© The author(s) 2024
Received:
31 Oct 2023
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Accepted:
20 Sep 2024
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Published Online:
26 Nov 2024
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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