Utility, comfort and feasibility of SARS-CoV-2 antigen rapid diagnostic testing integration into routine care: a cross-sectional survey assessing healthcare workers’ perspectives in Kenya and Cameroon

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Introduction: Integration of SARS-CoV-2 antigen rapid diagnostic testing (SARS-CoV-2 Ag-RDT) into maternal, neonatal and child health (MNCH), HIV and tuberculosis (TB) clinics may enhance early detection and prevention of COVID-19. We assessed healthcare workers' (HCWs') perceptions of integrating SARS-CoV-2 Ag-RDT in these clinics in Kenya and Cameroon. Methods: A cross-sectional survey was conducted in October 2022 among HCWs in 20 health facilities implementing SARS-CoV-2 Ag-RDT using two testing models: Screen and Test, screening all attendees and test those eligible, and Test All, screen and test all attendees. HCWs completed a 5-point Likert scale questionnaire exploring their perceptions on utility, comfort and feasibility. Results: A total of 355 HCWs (187 Screen and Test and 168 Test All) were surveyed, including 194 (55%) in MNCH, 123 (34.6%) in HIV and 38 (11%) in TB clinics. Most HCWs found integration useful: 325 (92%) agreed on its use for early identification and treatment of cases, and 318 (95%) agreed on its role in preventing the spread of SARS-CoV-2. Regarding HCW comfort, 342 (96%) felt at ease providing COVID-19 counselling, 204 (57%) felt comfortable performing SARS-CoV-2 testing, and 176 (50%) expressed concerns about the risk of infection during sample collection. HCWs noted that attendees refused testing due to discomfort with the procedure, lack of time and lack of perceived need. In terms of feasibility, 238 (71%) HCWs agreed it was possible to screen all clinic attendees and 113 (32%) expressed challenges integrating testing into routine care. Conclusions: HCWs found the integration of SARS-CoV-2 Ag-RDT useful; most felt comfortable providing counselling but had concerns regarding the safety of testing, particularly sample collection. Patient refusal due to discomfort, time constraints and a lack of perceived need were the main challenges to uptake. Integration strategies should reinforce infection prevention and control and build HCW capacity to improve uptake.

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