# Successful Integration of Community-Based Rapid Antigen Testing for COVID-19 and Malaria in Mali

## TL;DR

A community-based testing strategy for COVID-19 and malaria in Mali was more effective than the standard approach, but access to treatment remains a challenge.

## Contribution

Demonstrates the feasibility of integrating community-based rapid testing for both COVID-19 and malaria in a low-resource setting.

## Key findings

- Community-based testing led to significantly more malaria tests being performed compared to the standard-of-care approach.
- Only a small number of patients tested positive for COVID-19, and many refused or failed to reach healthcare facilities for referrals.
- Integrated testing improved malaria treatment rates among febrile patients in the community.

## Abstract

In Mali, access to health care facilities (HCFs) is limited due to distance and transportation costs, and this limitation may have led to an under detection of COVID-19 cases. This prospective randomized study compared a community-based, integrated COVID-19 and malaria testing strategy (intervention arm) to the national standard-of-care strategy (SOC arm). Four health areas were randomly assigned. All people seeking care who accepted the study were enrolled by community health workers (CHWs) and screened for COVID-19 symptoms. In the intervention arm, CHWs performed COVID-19 and/or malaria antigen rapid diagnostic tests (Ag-RDTs) for patients who met clinical criteria for possible COVID-19, including fever. In the SOC arm, CHWs referred patients who met clinical criteria for possible COVID-19, including fever, to the nearest health care facility (HCF) where COVID-19 and/or malaria Ag-RDTs were performed. Febrile patients refusing referral were tested for malaria by CHWs. Among 1,164 patients enrolled, 73% had fever and 72% meet clinical criteria for possible COVID-19. Malaria Ag-RDTs were performed in 79% and 3% COVID-19 suspected patients in intervention and SOC arms, respectively (P <0.001). Only three patients tested positive for COVID-19. Among 449 patients referred to HCFs, 248 refused to go to the HCFs, and only 10 of 201 who agreed to the referral actually reached one. Among febrile patients, 75% and 34% received malaria treatment in intervention and SOC arms, respectively (P <0.001). Integration of community-based testing for COVID-19 and malaria Ag-RDTs was found to be feasible. However, limited access to HCFs in rural areas highlights the need for treatment services to be available at the community level.