Using digital tools and antigen rapid testing to support household-level SARS-CoV-2 detection by community health workers in Rwanda: an operational pilot study

• Published in: BMJ open 2024-10, Vol.14 (10), p.e083410
• Main Authors: Nshimiyimana, Ladislas, Bigirimana, Noella, Ngabonziza, Jean-Claude S, Rwabihama, Jean-Paul, Rutayisire, Robert, Semakula, Muhammed, Rukundo, Gilbert, Mugabo, Hassan, Mutabazi, Josue, Mukamana, Beatrice, Mazarati, Jean-Baptiste, Kadam, Rigveda, Akinwusi, Olukunle, Suleiman, Khairunisa, Muvunyi, Claude Mambo, Akugizibwe, Paula
• Format: Article
• Language: English
• Subjects: Adult; Algorithms; Antigens; Community health care; Community Health Workers; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 diagnostic tests; COVID-19 Testing - methods; Decentralization; Diagnostics; Disease transmission; Female; Health facilities; health services; Humans; Infections; Laboratories; Male; Mass Screening - methods; Middle Aged; Original Research; Pandemics; Pilot Projects; public health; Questionnaires; Rural areas; Rwanda - epidemiology; SARS-CoV-2 - isolation & purification; Severe acute respiratory syndrome coronavirus 2; Smartphones; Tuberculosis; Young Adult
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-083410

ObjectiveTo evaluate the use of antigen-based rapid diagnostic tests (Ag-RDTs) alongside a digital tool to deliver household-level COVID-19 testing by community health workers (CHWs), in line with Rwanda’s ambition to decentralise COVID-19 testing.DesignThis was an operational pilot study to evaluate the impact and operational characteristics of using the digital e-ASCov tool combined with Ag-RDTs to support COVID-19 symptom screening and rapid testing by CHWs across eight districts in Rwanda. A total of 800 CHWs selected from both rural and urban areas were trained in delivering Ag-RDTs for COVID-19 testing and using the e-ASCOV application for data capture on a smartphone. Laboratory technicians repeated a subset of Ag-RDTs to assess the concordance of results obtained by CHWs. The study also assessed CHWs’ experience of the intervention using a mixed-methods approach.SettingEight rural, urban and semiurban districts in Rwanda.ParticipantsA total of 19 544 individuals were enrolled and screened for signs and symptoms of COVID-19.InterventionsCommunity-based screening for COVID-19 by CHWs using the digital tool e-ASCov combined with rapid testing using Ag-RDTs.Main outcome measuresNumber of participants screened and tested; concordance of Ag-RDT results between CHWs and laboratory technicians; feasibility of study procedures by CHWs and CHWs perceptions of the digital tool and Ag-RDT testing.ResultsFrom February to May 2022, CHWs screened 19 544 participants, of whom 4575 (23.4%) had COVID-19-related symptoms or a history of exposure to the infection. Among them, 86 (1.9%) were positive on Ag-RDTs. Concordance of Ag-RDT results between CHWs and laboratory technicians was 100%. Of the 800 trained CHWs, 746 (93.3%) were independently able to conduct household-based COVID-19 screening, perform the Ag-RDTs and send data to the central server. Most CHWs (>80%) found Ag-RDTs and e-ASCOV easy to use.ConclusionsThis study demonstrated the feasibility of deploying a digital tool and Ag-RDTs for household-level SARS-CoV-2 detection in Rwanda. The findings support a broader roll-out of digitally supported rapid testing by CHWs to broaden access to testing for priority diseases.