Combining rapid antigen testing and syndromic surveillance improves community-based COVID-19 detection in a low-income country

Fergus J. Chadwick (), Jessica Clark, Shayan Chowdhury, Tasnuva Chowdhury, David J. Pascall, Yacob Haddou, Joanna Andrecka, Mikolaj Kundegorski, Craig Wilkie, Eric Brum, Tahmina Shirin, A. S. M. Alamgir, Mahbubur Rahman, Ahmed Nawsher Alam, Farzana Khan, Ben Swallow, Frances S. Mair, Janine Illian, Caroline L. Trotter, Davina L. Hill, Dirk Husmeier, Jason Matthiopoulos, Katie Hampson and Ayesha Sania
Additional contact information
Fergus J. Chadwick: Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow
Jessica Clark: Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow
Shayan Chowdhury: a2i, United Nations Development Program, ICT Ministry
Tasnuva Chowdhury: Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow
David J. Pascall: MRC Biostatistics Unit, University of Cambridge
Yacob Haddou: Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow
Joanna Andrecka: Food and Agriculture Organisation of the United Nations in support of the UN Interagency Support Team
Mikolaj Kundegorski: COVID-19 in LMICs Research Group, University of Glasgow
Craig Wilkie: COVID-19 in LMICs Research Group, University of Glasgow
Eric Brum: Food and Agriculture Organisation of the United Nations in support of the UN Interagency Support Team
Tahmina Shirin: Institute of Epidemiology, Disease Control and Research, Ministry of Health
A. S. M. Alamgir: Institute of Epidemiology, Disease Control and Research, Ministry of Health
Mahbubur Rahman: Institute of Epidemiology, Disease Control and Research, Ministry of Health
Ahmed Nawsher Alam: Institute of Epidemiology, Disease Control and Research, Ministry of Health
Farzana Khan: Institute of Epidemiology, Disease Control and Research, Ministry of Health
Ben Swallow: COVID-19 in LMICs Research Group, University of Glasgow
Frances S. Mair: General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow
Janine Illian: COVID-19 in LMICs Research Group, University of Glasgow
Caroline L. Trotter: Departments of Pathology and Veterinary Medicine, University of Cambridge
Davina L. Hill: Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow
Dirk Husmeier: School of Mathematics and Statistics, University of Glasgow
Jason Matthiopoulos: Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow
Katie Hampson: Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow
Ayesha Sania: Division of Developmental Neuroscience, Department of Psychiatry, Columbia University

Nature Communications, 2022, vol. 13, issue 1, 1-9

Abstract: Abstract Diagnostics for COVID-19 detection are limited in many settings. Syndromic surveillance is often the only means to identify cases but lacks specificity. Rapid antigen testing is inexpensive and easy-to-deploy but can lack sensitivity. We examine how combining these approaches can improve surveillance for guiding interventions in low-income communities in Dhaka, Bangladesh. Rapid-antigen-testing with PCR validation was performed on 1172 symptomatically-identified individuals in their homes. Statistical models were fitted to predict PCR-status using rapid-antigen-test results, syndromic data, and their combination. Under contrasting epidemiological scenarios, the models’ predictive and classification performance was evaluated. Models combining rapid-antigen-testing and syndromic data yielded equal-to-better performance to rapid-antigen-test-only models across all scenarios with their best performance in the epidemic growth scenario. These results show that drawing on complementary strengths across rapid diagnostics, improves COVID-19 detection, and reduces false-positive and -negative diagnoses to match local requirements; improvements achievable without additional expense, or changes for patients or practitioners.

Date: 2022
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DOI: 10.1038/s41467-022-30640-w

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