Community-Based Delivery and Administration of Sars-CoV-2 Antigen Rapid Diagnostic Tests: An Operational Research Study in Marketplaces in Malawi and Zambia

To expand access to testing beyond public health facilities and to strengthen surveillance efforts for COVID-19, community testing using COVID-19 antigen-based rapid diagnostic tests (Ag-RDTs) was identified as a major area of focus in Malawi and Zambia. This research aimed to gather evidence on the feasibility and acceptability of community testing in marketplaces. A cross-sectional study with a mixed-methods design was conducted in marketplaces in Malawi and Zambia to understand operational considerations for the implementation of Ag-RDTs for SARS–CoV-2 in a community setting. Programmatic data were collected prospectively as individuals were tested from June to September 2022. COVID-19 testing was done using Abbott Panbio nasal swab test kits. Semi-qualitative questionnaires were administered to individuals who tested, healthcare workers, and site-based personnel. Data were collected electronically via the SurveyCTO platform and analyzed using STATA. In Malawi, 2,348 participants were tested, and in Zambia, 1,723 people were tested for COVID-19. In Zambia, participants were 46% female, with a median age of 28 years, whereas in Malawi, participants were 69% female, with a median age of 37 years. In Malawi, 78 positive cases were reported (3.3% positivity rate), and in Zambia 10 positive cases were reported (0.5% positivity rate). In Zambia, 99% of 300 participants and in Malawi, 92% of 1,158 testers found the market testing experience and sample collection acceptable. Community testing is a feasible and acceptable intervention to increase testing access in Malawi and Zambia, especially when coupled with community awareness campaigns and mobilization.