Introduction Despite the limited evidence for its effectiveness, thermal screening at points of entry has increasingly become a standard protocol in numerous parts of the globe in response to the COVID-19 pandemic. We sought to determine the effectiveness of thermal screening as a key step in diagnosing COVID-19 in a resource-limited setting. Materials and methods This was a retrospective cross-sectional study based on a review of body temperature and Xpert Xpress SARS CoV-2 test results records for truck drivers entering Uganda through Mutukula between 15th May and 30th July 2020. All records missing information for body temperature, age, gender, and Xpert Xpress SARS CoV-2 status were excluded from the data set. A data set of 7,181 entries was used to compare thermal screening and Xpert Xpress SARS CoV-2 assay test results using the diagnostic statistical test in STATAv15 software. The prevalence of COVID-19 amongst the truck drivers based on Xpert Xpress SARS CoV-2 assay results was determined. The sensitivity, specificity, positive predictive value, negative predictive value, positive and negative Likelihood ratios were obtained using Xpert Xpress SARS CoV-2 assay as the gold standard. Results Based on our gold standard test, the proportion of persons that tested positive for COVID-19 was 6.7% (95% CI: 6.1–7.3). Of the 7,181 persons that were thermally screened, 6,844 (95.3%) were male. The sample median age was 38 years (interquartile range, IQR: 31–45 years). The median body temperature was 36.5°C (IQR: 36.3–36.7) and only n (1.2%) had a body temperature above 37.5°C. The sensitivity and specificity of thermal screening were 9.9% (95% CI: 7.4–13.0) and 99.5% (95% CI: 99.3–99.6) respectively. The positive and negative predictive values were 57.8 (95% CI: 46.5–68.6) and 93.9 (95% CI: 93.3–94.4) respectively. The positive and negative Likelihood Ratios (LRs) were 19 (95% CI: 12.4–29.1) and 0.9 (95% CI: 0.88–0.93) respectively. Conclusion In this study population, the use of Thermal screening alone is ineffective in the detection of potential COVID-19 cases at point of entry. We recommend a combination of screening tests or additional testing using highly sensitive molecular diagnostics such as Polymerase Chain Reaction.

The project provides another example of how audit can be used as a tool to improve health practice, even in a low-resource setting. At the same time, it showed how difficult it is to achieve compliance with best hand hygiene practice in a low-resource hospital. The project highlights the importance of continued education/awareness raising on the importance of good hand hygiene practice as well as investment in infrastructure and cleaning supplies for achieving and sustaining good hand hygiene among workers in a low-resource hospital setting. A key contribution of the project was the legacy it left in the form of knowledge about how to use audit and feedback as a tool to promote the best practice. A similar project has been implemented in the maternity ward at the hospital and further audits are planned.

Expanding routine early infant diagnosis screening beyond the traditional PMTCT setting to nutrition and inpatient entry points will increase the identification of HIV-infected infants. Careful reflection for appropriate testing strategies, such as maternal re-testing to identify new HIV infections and HIV-exposed infants in need of follow-up testing and care, at immunization and outreach services should be considered given the expectedly low prevalence rates. These findings may help HIV care programmes significantly expand testing to improve access to early infant diagnosis and paediatric treatment.

These data suggest that the use of rapid serological tests may have inadequate performance as an indicator of exposure and potential HIV infection among infants presenting at both well-child (immunization and community outreach) and sick-infant (nutrition and inpatient) entry points. To improve the identification of HIV-positive infants, nucleic acid-based testing should instead be considered in infants aged younger than 18 months.

BackgroundWorld Health Organisation recommends that malaria case management be based on parasite-based diagnosis in all cases, but currently available tools for clinical use have limitations, including the inability to detect low-level infections. Currently, next-generation highly sensitive rapid diagnostic tests (hsRDT) for Plasmodium falciparum (Pf) are commercially available, but require field-based validation. This study evaluated the performance of the highly sensitive NxTek™ Eliminate Malaria Pf (NxTek) diagnostic test in health facilities and community settings in Mpigi district, Uganda in comparison to the conventional rapid diagnostic tests (cRDTs).MethodsBetween April and December 2019, symptomatic and asymptomatic participants were randomly enrolled from the Outpatient Department (OPD), Antenatal Care (ANC), and community settings. The participants were tested with both cRDTs and an hsRDT to detect Plasmodium falciparum HRP2 antigen and quality assured results with PCR as a reference. Geo-coded real time data were transmitted by health facility and community-based providers using a smartphone with custom designed software.ResultsAt the OPD, the parasite positivity rate was 13.3% for HS-RDT, compared to 6.4% with cRDT. The HS-RDT detected twice the number of positives compared to cRDT. At ANC, 11% (384/3,490) of the pregnant women were malaria parasite positive. HS-RDT detected more positive cases (10.4%) than cRDT (7.0%). At the community setting, 79.7% (2,397/3,009) of the under-five age group were positive for malaria parasites. Index clients in households resulted in a detection of 21.1% (1,877) asymptomatic positive especially among school going children. Health workers were able to learn how to effectively perform the HS-RDT, from a one-day training session. The additional support supervision was provided for VHTs to enable all to transmit results through the android phones. ConclusionUse of HS-RDTs increased case findings of low parasite density infections compared to cRDTs in study populations and provides the opportunity to eliminate malaria reservoirs through treatments. There were minimal additional training requirements when the HS-RDT kits were introduced. The observed increased positivity rates among school-age children call for integrating targeted interventions into school health programs.