Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya.
Kenya Forestry Research Institute, Nairobi, Kenya.
PLoS One. 2023 Sep 8;18(9):e0290575. doi: 10.1371/journal.pone.0290575. eCollection 2023.
Kenya has registered over 300,000 cases of COVID-19 and is a high-burden tuberculosis country. Tuberculosis diagnosis was significantly disrupted by the pandemic. Access to timely diagnosis, which is key to effective management of tuberculosis and COVID-19, can be expanded and made more efficient through integrated screening. Decentralized testing at community level further increases access, especially for underserved populations, and requires robust systems for data and process management. This study delivered integrated COVID-19 and tuberculosis testing to commercial motorbike (Bodaboda) riders, a population at increased risk of both diseases with limited access to services, in four counties: Nairobi, Kiambu, Machakos and Kajiado. Testing sheds were established where riders congregate, with demand creation carried out by the Bodaboda association. Integrated symptom screening for tuberculosis and COVID-19 was conducted through a digital questionnaire which automatically flagged participants who should be tested for either, or both, diseases. Rapid antigen-detecting tests (Ag-RDTs) for COVID-19 were conducted onsite, while sputum samples were collected and transported to laboratories for tuberculosis diagnosis. End-to-end patient data were captured using digital tools. 5663 participants enrolled in the study, 4946 of whom were tested for COVID-19. Ag-RDT positivity rate was 1% but fluctuated widely across counties in line with broader regional trends. Among a subset tested by PCR, positivity was greater in individuals flagged as high risk by the digital tool (8% compared with 4% overall). Of 355 participants tested for tuberculosis, 7 were positive, with the resulting prevalence rate higher than the national average. Over 40% of riders had elevated blood pressure or abnormal sugar levels. The digital tool successfully captured complete end-to-end data for 95% of all participants. This study revealed high rates of undetected disease among Bodaboda riders and demonstrated that integrated diagnosis can be delivered effectively in communities, with the support of digital tools, to maximize access.
肯尼亚已登记超过 30 万例 COVID-19 病例，且是结核病负担高的国家。大流行显著扰乱了结核病诊断。及时诊断是结核病和 COVID-19 有效管理的关键，可以通过综合筛查来扩大并提高效率。在社区层面进行分散检测可进一步增加获得诊断的机会，特别是为服务不足的人群，并且需要建立强大的数据和流程管理系统。本研究在四个县（内罗毕、基安布、马查科斯和卡贾多）为商业摩托车（Bodaboda）骑手提供了 COVID-19 和结核病综合检测，这些骑手是两种疾病风险增加、服务获取机会有限的人群。在骑手聚集的地方设立了检测棚，由 Bodaboda 协会开展需求创造工作。通过数字问卷对结核病和 COVID-19 进行综合症状筛查，该问卷可自动标记出应进行任何一种或两种疾病检测的参与者。在现场进行 COVID-19 的快速抗原检测（Ag-RDT），同时采集痰液样本并运送到实验室进行结核病诊断。使用数字工具采集端到端的患者数据。5663 名参与者入组研究，其中 4946 人接受了 COVID-19 检测。Ag-RDT 阳性率为 1%，但与更广泛的区域趋势一致，在各县之间波动很大。在使用 PCR 进行检测的亚组中，数字工具标记为高风险的个体的阳性率更高（8%，而总体阳性率为 4%）。在 355 名接受结核病检测的参与者中，有 7 人呈阳性，检出率高于全国平均水平。超过 40%的骑手血压或血糖水平升高。数字工具成功捕获了所有参与者 95%的完整端到端数据。本研究揭示了 Bodaboda 骑手未被发现的疾病率很高，并表明在数字工具的支持下，可在社区中有效地提供综合诊断，以最大限度地提高可及性。
