# Assessing the Benefit of Two Detection Approaches in Screening COVID-19 Using SARS-CoV-2 Antigen Rapid Diagnostic Tests among Intercity Public Bus Travelers in Cameroon

## TL;DR

This study evaluated using rapid antigen tests to screen bus travelers in Cameroon for COVID-19, finding it feasible and acceptable but needing improvements to reduce travel by infected individuals.

## Contribution

The study introduces a practical approach for using antigen rapid diagnostic tests in intercity bus travel settings to mitigate the spread of COVID-19.

## Key findings

- Offering systematic testing detected 0.8% positive cases among 9,594 participants.
- Only 14.3% of positive cases agreed to postpone travel, indicating a need for behavioral interventions.
- Testing did not cause travel delays, and one-third of passengers consented to participate.

## Abstract

The movement of people contributes to the spread of COVID-19 between communities. Hence, we evaluated the feasibility, acceptability, and impact of offering intercity bus travelers testing prior to their departure. We conducted baseline and endline surveys to map COVID-19 prevention practices in travel agencies in western Cameroon. As interventions, buses were randomly assigned to three study arms: 1) offering systematic COVID-19 rapid diagnostic testing (RDT) to all passengers (arm A); 2) offering testing to suspected cases (arm B); or 3) no testing (arm C). All travelers were called 7–10 days after their trip to identify potential cases. Fifty-five (90.2%) of the 61 travel agencies that were reached consented to participate in a baseline survey. Although only 27 (49.1%) of the agencies implemented at least one of the recommended COVID-19 preventive measures, 39 (70.9%) agreed to host a testing station. Six agencies were selected, and 669 buses were enrolled, including 223, 224, and 222 in arms A, B, and C, respectively. A total of 31,484 departing passengers were approached and 9,594 (30.5%) agreed to participate: 1,177 (12.3%) in arm A, 4,086 (42.6%) in arm B, and 4,331 (45.1%) in arm C. In all, 1,731 tests were performed, including 1,177 in arm A and 554 in arm B. Fourteen (0.8%) tests were positive, and two participants (14.3%) agreed to postpone their travel. Offering testing with antigen RDTs in travel agencies is feasible and acceptable. One-third of passengers consented, and testing did not delay any travels. Although this approach can detect COVID-19 cases, actions are needed to increase the proportion of positive cases postponing their travels.