Assessing time requirements of two models of SARS-CoV-2 screening and testing in routine healthcare services in Kenya and Cameroon: a descriptive study

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Introduction: Incorporating SARS-CoV-2 antigen-detecting rapid diagnostic tests (Ag-RDTs) into routine care settings can facilitate efficient case identification and management in low-resource settings. We assessed the time required to complete SARS-CoV-2 screening and Ag-RDT testing in maternal, neonatal and child health (MNCH), HIV and tuberculosis clinics in selected facilities in Kenya and Cameroon. Methods: We conducted a descriptive, time-motion analysis comparing SARS-CoV-2 screening and testing through standard-of-care 'screen-and-test' (ST) and 'test-all' (TA) models. Study staff observed and documented time in minutes taken by healthcare workers to provide SARS-CoV-2 services. Time taken per model was compared using the Wilcoxon rank-sum (Mann-Whitney) or Kruskal-Wallis test. Results: A total of 116 observations of SARS-CoV-2 screening and testing using Ag-RDTs were conducted. The overall time spent on SARS-CoV-2 activities for clients was a median of 34 min (IQR: 25, 41) for ST sites and 21 min (IQR: 15, 27) at TA sites, p=0.001. Screening took a median time of 3 min (IQR: 2, 7) at ST sites. Among activities observed, test processing took the longest at 19 min (IQR: 17, 21) in ST sites versus 16 min (IQR: 15, 18.5) in TA sites, p=0.001. Conclusions: SARS-CoV-2 screening and testing services in routine healthcare services took slightly longer in the ST model compared with the TA model, with the majority of additional time needed for sample processing/testing in both models. However, in high-volume clinics, the additional 21 min of personnel and client time needed to test every attendee may not be feasible compared with the 34 min of additional time needed for testing only eligible attendees. When considering the model to use, clinic workload and human resource availability need to be considered to manage the time required for providing SARS-CoV-2 services. Trial registration number: NCT05382130 17 May 2022.

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