Improving access to Covid-19 testing in West Africa – Introduction of antigenic tests in Mali and Niger
Restitution of the results of the ECOVAN/ECOVAM studies
5 July 2022
The ECOVAN/ECOVAM studies in Mali and Niger evaluated the introduction of antigenic tests for COVID-19, combined with a triage strategy for symptomatic patients.
The medical triage strategy allowed :
- +360% of suspected cases detected and offered a rapid antigen test
The antigenic tests were :
- well accepted by caregivers and patients
- efficient: +170% of Covid-19 cases detected compared to PCR test
- reliable: 90% of antigenic rapid tests confirmed by PCR
According to figures from the continent’s Centre for Disease Control and Prevention (Africa CDC), as of 13 June 2022, Africa has had more than 11 million cases of infection since the start of the pandemic and 253,581 deaths. According to WHO statistics, this figure could be seven times higher, mainly due to the large number of asymptomatic patients and the great lack of screening facilities observed on the continent since the start of the pandemic.
Indeed, major challenges remain to be met in order to effectively combat the Covid-19 pandemic, and in particular to provide all levels of health care (from university hospitals to health huts) with effective screening facilities in order to continue to monitor and contain the pandemic and refer serious cases to hospitals.
Testing new screening strategies
The ECOVAM/ECOVAN studies were implemented in Mali and Niger with the support of FIND, in 2021, to test a new Covid-19 screening strategy in 15 health facilities at all levels of the health pyramid in the capital and in the regions, the majority of which lacked the means to diagnose Covid-19. Indeed, before this study, Covid-19 diagnosis was based on the PCR test, which was only available in a few laboratories, all located in the capital, Bamako and Niamey. Furthermore, the majority of PCR tests were performed for travel purposes and only a minority of people suspected of being infected with Covid-19 were identified in health facilities.
The screening strategy of the ECOVAM/ECOVAN studies was based on a systematic triage of patients presenting for routine or emergency medical consultations at the participating health facilities for Covid-19 symptoms. In case of symptoms, patients were offered an antigen test.
Antigenic tests, an effective solution, more suitable than the PCR test
The implementation of this strategy has led to a 170% increase in the number of Covid-19 cases detected compared to the PCR test, demonstrating the importance of the circulation of the virus in the communities, in the capital as well as in the regions, with a prevalence of up to 27% in Mali, where the study has also documented the first Covid-19 cases outside the capital, in the district of Fana.
In addition to being easy to use, the rapid tests have been well accepted by health care providers and patients, thus improving the speed of management of patients infected with COVID-19.
+170% in the number of Covid-19 cases detected through the use of antigenic tests compared to PCR during the study period
“The arrival of the Ecovan project has improved our management of Covid-19. The introduction of the rapid detection tests has reduced the time between the test and the results. It takes half an hour at the most, whereas if you remember at the beginning of the pandemic, you had to wait for a team to take the sample, then send the samples to a research centre, and wait for the result to be done, and at the time there were a lot of samples, so it could take up to 24 hours. So for 24 hours, the patient was sampled, he knows he is a suspect but he doesn’t know if he is positive or negative and he lives in this stress for 24 hours, so it was really hard for the patients, but it was also hard for the health staff, because we didn’t know what decision to make for this patient for 24 hours”. Dr Eric Adehossi, Head of the National Care Commission Covid-19 in Niger
⇒Our video presentation of the project (in french) :
This system has also helped to make the Covid-19 less dramatic in health establishments: “Before, we hesitated, because it generated complications: you exposed yourself to the waiting time, to the discontent of impatient patients. The wait was unbearable for the patient and for the carer, and we tended to reassure them that ‘it’s certainly not the Covid-19’. We were minimising, we were thinking about something else”, reports a health worker from a centre supported by the project in Niger.
Antigenic tests, a reliable solution
The ECOVAN/ECOVAM study also confirmed the reliability of the antigenic tests compared to the PCR test. Conducted in close collaboration with the Centre de Recherche Médicale et Sanitaire au Niger (CERMES), all the antigenic tests performed in Niger were doubled with a PCR test to measure their reliability, thus demonstrating a reliability rate of 9/10 of the antigenic tests. Similar results were obtained in Mali for patients who received a confirmatory PCR test.
90% of the antigenic rapid tests were confirmed by the same PCR result.
An optimised triage system
The implementation of systematic medical triage at the consultation stage led to a 360% increase in the number of suspected COVID cases compared to the triage system at the entrance to the health facility in Mali. The use of WHO COVID-19 criteria in triage increased the number of COVID-19 suspects by 30-50% in Mali and Niger respectively. In fact, the search for signs of COVID is often limited to cough and fever, whereas the symptoms of COVID-19 are very numerous. In Niger, a computer application on tablets configured on the basis of the WHO criteria for identifying COVID-19 has been set up to assist health care staff in detecting symptoms and therefore suspect cases.
+ 30-50% increase in the number of suspected cases detected through the use of the WHO criteria
+ 360% increase in the number of suspected cases detected thanks to the implementation of systematic medical triage.
Although access to diagnostics is only one step in the fight against the Covid-19 pandemic, the results of this study demonstrate that rapid antigenic tests are a reliable, effective and easy-to-use tool that can be used at all levels of the health pyramid, including community health centres, to continue mass screening and stay ahead of the pandemic,” said Dr Moeti, WHO Regional Director for Africa: “The tests give us the opportunity to monitor the virus in real time, to track its evolution and to assess the emergence of new variants. If we want to stay ahead of COVID-19, countries need to step up screening, contact tracing and surveillance.
For more information: see the project sheet