Rapid antigen testing by community health workers for detection of SARS-CoV-2 in Dhaka, Bangladesh: a cross-sectional study
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 technicia...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e060832.full |
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| author | Mahbubur Rahman Ayesha Sania Seonjoo Lee Tahmina Shirin A S M Alamgir Yael K Rayport Ahmed Nawsher Alam Joanna Andrecka Eric Brum Fergus Chadwick Tasnuva Chowdhury Zakiul Hasan Davina L Hill Farzana Khan Mikolaj Kundegorski Motahara Tasneem Katie Hampson |
| author_facet | Mahbubur Rahman Ayesha Sania Seonjoo Lee Tahmina Shirin A S M Alamgir Yael K Rayport Ahmed Nawsher Alam Joanna Andrecka Eric Brum Fergus Chadwick Tasnuva Chowdhury Zakiul Hasan Davina L Hill Farzana Khan Mikolaj Kundegorski Motahara Tasneem Katie Hampson |
| author_sort | Mahbubur Rahman |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-0ac30c1ad61f4418ad356a02faefe00d |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-0ac30c1ad61f4418ad356a02faefe00d2025-01-28T08:50:09ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2022-060832Rapid antigen testing by community health workers for detection of SARS-CoV-2 in Dhaka, Bangladesh: a cross-sectional studyMahbubur Rahman0Ayesha Sania1Seonjoo Lee2Tahmina Shirin3A S M Alamgir4Yael K Rayport5Ahmed Nawsher Alam6Joanna Andrecka7Eric Brum8Fergus Chadwick9Tasnuva Chowdhury10Zakiul Hasan11Davina L Hill12Farzana Khan13Mikolaj Kundegorski14Motahara Tasneem15Katie Hampson16Department of Epidemiology, Institute of Epidemiology Disease Control and Research, Dhaka, BangladeshPsychiatry, Columbia University Irving Medical Center, New York City, New York, USADivision of Mental Health Data Science, New York State Psychiatric Institute, New York, New York, USAInstitute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, BangladeshInstitute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, BangladeshNeuroscience, New York State Psychiatric Institute, New York City, New York, USADepartment of Virology, Institute of Epidemiology Disease Control and Research, Dhaka, BangladeshFood and Agriculture Organization of the United Nations, Dhaka, BangladeshFood and Agriculture Organization of the United Nations, Dhaka, BangladeshUniversity of Glasgow Institute of Biodiversity Animal Health and Comparative Medicine, Glasgow, UKUniversity of Glasgow Institute of Biodiversity Animal Health and Comparative Medicine, Glasgow, UKFood and Agriculture Organization of the United Nations, Dhaka, BangladeshUniversity of Glasgow Institute of Biodiversity Animal Health and Comparative Medicine, Glasgow, UKDepartment of Epidemiology, Institute of Epidemiology Disease Control and Research, Dhaka, BangladeshUniversity of Glasgow Institute of Biodiversity Animal Health and Comparative Medicine, Glasgow, UKFood and Agriculture Organization of the United Nations, Dhaka, BangladeshUniversity of Glasgow Institute of Biodiversity Animal Health and Comparative Medicine, Glasgow, UKObjective 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.https://bmjopen.bmj.com/content/12/6/e060832.full |
| spellingShingle | Mahbubur Rahman Ayesha Sania Seonjoo Lee Tahmina Shirin A S M Alamgir Yael K Rayport Ahmed Nawsher Alam Joanna Andrecka Eric Brum Fergus Chadwick Tasnuva Chowdhury Zakiul Hasan Davina L Hill Farzana Khan Mikolaj Kundegorski Motahara Tasneem Katie Hampson Rapid antigen testing by community health workers for detection of SARS-CoV-2 in Dhaka, Bangladesh: a cross-sectional study BMJ Open |
| title | Rapid antigen testing by community health workers for detection of SARS-CoV-2 in Dhaka, Bangladesh: a cross-sectional study |
| title_full | Rapid antigen testing by community health workers for detection of SARS-CoV-2 in Dhaka, Bangladesh: a cross-sectional study |
| title_fullStr | Rapid antigen testing by community health workers for detection of SARS-CoV-2 in Dhaka, Bangladesh: a cross-sectional study |
| title_full_unstemmed | Rapid antigen testing by community health workers for detection of SARS-CoV-2 in Dhaka, Bangladesh: a cross-sectional study |
| title_short | Rapid antigen testing by community health workers for detection of SARS-CoV-2 in Dhaka, Bangladesh: a cross-sectional study |
| title_sort | rapid antigen testing by community health workers for detection of sars cov 2 in dhaka bangladesh a cross sectional study |
| url | https://bmjopen.bmj.com/content/12/6/e060832.full |
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