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Successful Integration of Community-Based Rapid Antigen Testing for COVID-19 and Malaria in Mali
Guillaume Breton
guillaume.breton@solthis.org
Guillaume Breton
SOLTHIS, Paris, France;
Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Paris, France;
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Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Paris, France;
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Issouf Maïga
Issouf Maïga
Solthis, Bamako, Mali;
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Aboubacar Maïga
Aboubacar Maïga
Solthis, Bamako, Mali;
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Gabrièle Laborde Balen
Gabrièle Laborde Balen
IRD-TransVIHMI UMI 233/ INSERM 1175 Université de Montpellier, Montpellier, France;
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Luis Sagaon-Teyssier
Luis Sagaon-Teyssier
Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France;
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Anne Hoppe
Anne Hoppe
FIND, Geneva, Switzerland;
Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland;
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Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland;
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Odé Kanku Kabemba
Odé Kanku Kabemba
Solthis, Bamako, Mali;
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Boubacar Cissé
Boubacar Cissé
Solthis, Bamako, Mali;
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Fatou Diawara Traore
Fatou Diawara Traore
National Institut of Public Health (INSP), Bamako, Mali
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In Mali, access to health care facilities (HCFs) is limited due to distance and transportation costs, and this limitation may have led to an under detection of COVID-19 cases. This prospective randomized study compared a community-based, integrated COVID-19 and malaria testing strategy (intervention arm) to the national standard-of-care strategy (SOC arm). Four health areas were randomly assigned. All people seeking care who accepted the study were enrolled by community health workers (CHWs) and screened for COVID-19 symptoms. In the intervention arm, CHWs performed COVID-19 and/or malaria antigen rapid diagnostic tests (Ag-RDTs) for patients who met clinical criteria for possible COVID-19, including fever. In the SOC arm, CHWs referred patients who met clinical criteria for possible COVID-19, including fever, to the nearest health care facility (HCF) in where COVID-19 and/or malaria Ag-RDTs were performed. Febrile patients refusing referral were tested for malaria by CHWs. Among 1,164 patients enrolled, 73% had fever and 72% meet clinical criteria for possible COVID-19. Malaria Ag-RDTs were performed in 79% and 3% COVID-19 suspected patients in intervention and SOC arms, respectively (P <0.001). Only three patients tested positive for COVID-19. Among 449 patients referred to HCFs, 248 refused to go tho the HCFs, and only 10 of 201 who agreed to the referral actually reached one. Among febrile patients, 75% and 34% received malaria treatment in intervention and SOC arms, respectively (P <0.001). Integration of community-based testing for COVID-19 and malaria Ag-RDTs was found to be feasible. However, limited access to HCFs in rural areas highlights the need for treatment services to be available at the community level.
Author Notes
Financial support: The study was supported through FIND, through a grant FIND received from the German Federal Ministry for Economic Cooperation and Development (BMZ).
Current contact information: Guillaume Breton, SOLTHIS and Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Paris, France. E-mail: guillaume.breton@solthis.org; Issouf Maïga, Solthis, Niamey, Niger. E-mail: cdp.atdsdeid.niger@solthis.org; Aboubacar Maïga, Solthis, Bamako, Mali. E-mail: aboubacarmaiga5555@gmail.com; Gabrièle Laborde-Balen, TransVIHMI, Montpellier University, INSERM, IRD, Montpellier, France. E-mail : gabriele.laborde-balen@ird.fr; Luis Sagaon-Teyssier, Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France. E-mail: luis.sagaon-teyssier@ird.fr; Anne Hoppe, Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland. E-mail: ahoppe@pedaids.org; Odé Kanku Kabemba, Solthis, Conakry, Guinea. E-mail: dirpaysguinee@solthis.org; Boubacar Cissé, Solthis, Bamako, Mali. E-mail: dirpays.mali@solthis.org; Fatou Diawara Traore, National Institut of Public Health (INSP), Bamako, Mali. E-mail: diawarafatou@gmail.com.
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