Feasibility and Acceptability of SARS-CoV-2 Antigen Rapid Diagnostic Testing in High-Risk Markets and Trade Hubs in Kampala, Uganda.

Congregate settings are high-risk places for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, making strategies that rely solely on hospital-based testing ineffective in curbing transmissions. We therefore evaluated the feasibility, utility, and acceptability of testing with SARS-CoV-2 antigen rapid diagnostic tests (Ag-RDTs) in markets and trade hubs in Kampala, Uganda. Between June and September 2022, we conducted a prospective operational research study in five divisions of Kampala. Four rounds of monthly cross-sectional surveys were conducted at one market and one trading hub per division, resulting in a total of 13,086 volunteers tested. Females were more likely than males to be tested (54% versus 46%), which aligns with sex-based differences in health-seeking behavior. More tests were conducted in markets (68%) compared with trade centers (32%). Several interventions increased overall demand for testing, including 1) awareness campaigns and mobilization activities; 2) the movement of teams across congregate settings; 3) the optimization of workflow; and 4) testing traders at their workstations. The overall positivity rate during the 4 months was 0.6% (78/13,086). There was a steady decline in positivity rates by month, aligning with the trend observed at the national level. Of the 78 positive index cases identified, 105 contacts were traced; 71% of these could be reached. None of the positive patients successfully self-isolated for the 14 days specified in national guidelines. Nevertheless, this study demonstrates that testing market dwellers with Ag-RDTs is not only acceptable and feasible in Uganda but also an important public health tool for the timely detection of SARS-CoV-2. This approach may be replicated in similar settings.