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

Chadwick, Fergus J. ORCID logoORCID:, Clark, Jessica ORCID logoORCID:, Chowdhury, Shayan ORCID logoORCID:, Chowdhury, Tasnuva ORCID logoORCID:, Pascall, David J. ORCID logoORCID:, Haddou, Yacob, Andrecka, Joanna, Kundegorski, Mikolaj ORCID logoORCID:, Wilkie, Craig ORCID logoORCID:, Brum, Eric ORCID logoORCID:, Shirin, Tahmina, Alamgir, A.S.M., Rahman, Mahbubur ORCID logoORCID:, Alam, Ahmed Nawsher ORCID logoORCID:, Khan, Farzana, Swallow, Ben ORCID logoORCID:, Mair, Frances S., Illian, Janine ORCID logoORCID:, Trotter, Caroline L. ORCID logoORCID:, Hill, Davina L. ORCID logoORCID:, Husmeier, Dirk ORCID logoORCID:, Matthiopoulos, Jason ORCID logoORCID:, Hampson, Katie ORCID logoORCID: and Sania, Ayesha (2022) Combining rapid antigen testing and syndromic surveillance improves community-based COVID-19 detection in a low-income country. Nature Communications, 13 (1). p. 2877.

[thumbnail of Hill_CombiningRapid.pdf]
PDF - Published Version
Available under License CC BY

Download (1MB) | Preview
Official URL:


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: Article
Journal / Publication Title: Nature Communications
Publisher: Nature Research
ISSN: 2041-1723
Departments: Institute of Science and Environment > STEM
Additional Information: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Davina Hill was Lecturer in Zoology at University of Cumbria, UK from 2016 to 2019.
Depositing User: Insight Administrator
SWORD Depositor: Insight Administrator
Date Deposited: 05 Jul 2022 13:17
Last Modified: 05 Dec 2022 10:30


Downloads per month over past year

Downloads each year

Edit Item