Feasibility and acceptability of a digital tool to support community-based screening for COVID-19 and other priority medical conditions across rural and peri-urban communities in Guinea

Abstract

Access to primary healthcare, including diagnostic testing, is limited in Guinea, particularly for low-income residents of rural communities. Here we share findings from an interventional operational research study evaluating the feasibility of deploying a digital tool and rapid diagnostic tests to support community-based testing for priority medical conditions across three rural and peri-urban communities in Guinea. An existing web-based application was modified to include integrated symptom screening for malaria and COVID-19, maximize workflow efficiency and conduct end-to-end data capture on tablet devices. Using the application, community health workers screened participants for symptoms of malaria and COVID-19, with eligible participants tested using rapid diagnostic tests. All participants also underwent blood pressure and blood glucose measurements, while malnutrition screening was offered to pregnant women or children under 5 years. Services were provided to residents through mass consultations and home care visits across the study locations. The intervention reached 5204 people overall, with 3241 people enrolled via the application. 32.4% and 15.8% of participants had elevated blood pressure and blood glucose levels, the majority of whom were previously undiagnosed. Of those tested for malaria, 3.2% (n = 28/876) tested positive. The digital tool was successful in providing end-to-end data capture, with 99% of participants having their rapid diagnostic test results captured in real-time, and all outcomes reported into the Ministry of Health database. Together, the study demonstrates the feasibility of using a web-based digital tool to support community health workers with providing community-based diagnostic services in rural and peri-urban communities in a low-resource setting.

Keywords: Guinea; NCDs; community-based screening; diagnosis; digital; malaria.

Figure 1

Community-based testing model workflow^*. BP, blood pressure; CHW, community health worker; MoH, Ministry of Health; NCD, noncommunicable disease; RDT, rapid diagnostic test; SPO2, oxygen saturation level; y.o., years old. ^* Biowaste was placed into containers and disposed of at the bin of the nearest community health centre.

Figure 2

Proportion of participants testing positive for COVID-19 and malaria

Figure 3

Participant blood pressure measurements by category and sex

Figure 4

Participant blood pressure measurements by category and sex

Figure 5

Participant referral to community health centre by condition and location