Integrating SARS-CoV-2 rapid antigen testing in maternal, neonatal and child health, HIV, and TB clinics in Kenya and Cameroon: outcomes from the Catalysing COVID-19 Action Project

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Introduction: Early diagnosis of SARS-CoV-2 infection is key to preventing severe disease and poor outcomes in vulnerable populations, such as pregnant women and people living with HIV or diagnosed with tuberculosis (TB). We assessed outcomes achieved with the integration of SARS-CoV-2 antigen-detecting rapid diagnostic testing (Ag-RDT) into maternal, neonatal and child health (MNCH); HIV and TB clinics in the Catalysing COVID-19 Action project. Methods: Screening and testing for SARS-CoV-2 per national guidelines were integrated into MNCH, HIV and TB clinics in 50 health facilities in Cameroon and Kenya. In Cameroon, screening and testing were done by existing facility staff, while in Kenya, additional community workers and laboratory staff were involved. Clients aged >2 years attending MNCH, HIV and TB clinics between May and October 2022 were included in the study. We estimated the proportion of participants screened, tested and tested positive; calculated the SARS-CoV-2 case detection rate per 1000 attendees and determined factors associated with screening, testing and positivity. Results: Overall, 528 567 attendee visits were reported in Cameroon (282 404) and Kenya (246 163), with screening for SARS-CoV-2 performed in 256 049 (48.4%), showing substantive variations between countries (62.6% in Cameroon and 32.2% in Kenya). Among the 256 049 screened, 19 013 (7.4%) were eligible for testing (9.0% in Cameroon and 3.9% in Kenya), of whom 12 934 (68.0%) were tested for SARS-CoV-2 including 9866/15 934 (61.9%) in Cameroon and 3068/3079 (96.6%) in Kenya. A total of 390 (3.0%) positive tests were identified (329/9866, 3.3%, in Cameroon and 61/3068, 2.0%, in Kenya). Country integration strategy, facility level, setting and clinic were independently associated with screening and testing. Conclusions: Integration of SARS-CoV-2 Ag-RDT in MNCH, HIV and TB clinics in both countries allowed detection of SARS-CoV-2 cases among vulnerable populations. Integration strategies should consider facility settings and additional human resources in high-volume facilities to improve screening and testing proportions. Trial registration number: NCT05498727.

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