Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
Department of Virology, Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh.
BMJ Open. 2022 Jun 1;12(6):e060832. doi: 10.1136/bmjopen-2022-060832.
To evaluate the diagnostic performance and feasibility of rapid antigen testing for SARS-CoV-2 detection in low-income communities.
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.
Low-income communities in Dhaka, Bangladesh.
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).
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.
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.
评估快速抗原检测在低收入社区中用于 SARS-CoV-2 检测的诊断性能和可行性。
我们进行了一项基于社区的横断面诊断准确性研究。经过医学技术人员培训和监督的社区卫生工作者对有症状的个体以及其家庭中最多两名其他家庭成员进行了快速抗原检测，并将诊断结果与金标准 RT-PCR 进行了校准。
孟加拉国达卡的低收入社区。
2021 年 5 月 19 日至 7 月 11 日期间，共采集了 1240 份来自有症状个体的鼻腔和唾液样本，以及 993 份来自最多两名其他家庭成员（每户 1 人至 2 人）的样本。
快速抗原检测在鼻腔样本中的敏感性为 0.68（95%CI 0.62 至 0.73），在唾液样本中的敏感性为 0.41（95%CI 0.35 至 0.46），鼻腔样本的特异性也高于唾液样本（0.98，95%CI 0.97 至 0.99），而唾液样本的特异性为 0.87（95%CI 0.85 至 0.90）。对最多两名其他家庭成员进行检测，可将鼻腔样本的敏感性提高至 0.71（95%CI 0.65 至 0.76），但特异性会降低（0.96，95%CI 0.94 至 0.97）。对两名其他家庭成员进行检测，可使唾液样本的敏感性提高至 0.48（95%CI 0.42 至 0.54），但仍低于鼻腔样本的敏感性。在研究期间，通过动员社区卫生工作者进行样本采集，使这些低收入社区的检测量增加了四倍。
社区卫生工作者可有效进行鼻腔拭子的快速抗原检测，其敏感性和特异性与文献中的结果相当。在资源匮乏的环境中，由社区卫生工作者对家庭进行检测是一种廉价的方法，可以通过即时可行的检测结果提高检测能力、可及性和控制措施的有效性。
