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

Sania, Ayesha ORCID logo ORCID: https://orcid.org/0000-0002-6445-9481 , Alam, Ahmed Nawsher, Alamgir, A.S.M., Andrecka, Joanna, Brum, Eric ORCID logo ORCID: https://orcid.org/0000-0002-0244-7178 , Chadwick, Fergus, Chowdhury, Tasnuva, Hasan, Zakiul, Hill, Davina ORCID logo ORCID: https://orcid.org/0000-0001-9085-6192 , Khan, Farzana, Kundegorski, Mikolaj, Lee, Seonjoo ORCID logo ORCID: https://orcid.org/0000-0003-3177-6357 , Rahman, Mahbubur ORCID logo ORCID: https://orcid.org/0000-0001-8577-8281 , Rayport, Yael K., Shirin, Tahmina, Tasneem, Motahara and Hampson, Katie (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.

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Official URL: https://doi.org/10.1136/bmjopen-2022-060832


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: Article
Journal / Publication Title: BMJ Open
Publisher: BMJ Publishing Group
ISSN: 2044-6055
Departments: Institute of Science and Environment > Forestry and Conservation
Additional Information: This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/ licenses/by/4.0/.
Depositing User: Insight Administrator
SWORD Depositor: Insight Administrator
Date Deposited: 05 Jul 2022 11:33
Last Modified: 13 Jan 2024 13:30
URI: https://insight.cumbria.ac.uk/id/eprint/6487


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