Kenya has registered over 300000 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.