Geospatial Point-of-Care Testing Strategies for COVID-19 Resilience in Resource-Poor Settings: Rural Cambodia Field Study - PubMed (original) (raw)
Geospatial Point-of-Care Testing Strategies for COVID-19 Resilience in Resource-Poor Settings: Rural Cambodia Field Study
Gerald Joseph Kost et al. JMIR Public Health Surveill. 2024.
Abstract
Background: Point-of-care testing (POCT) generates intrinsically fast, inherently spatial, and immediately actionable results. Lessons learned in rural Cambodia and California create a framework for planning and mobilizing POCT with telehealth interventions. Timely diagnosis can help communities assess the spread of highly infectious diseases, mitigate outbreaks, and manage risks.
Objective: The aims of this study were to identify the need for POCT in Cambodian border provinces during peak COVID-19 outbreaks and to quantify geospatial gaps in access to diagnostics during community lockdowns.
Methods: Data sources comprised focus groups, interactive learners, webinar participants, online contacts, academic experts, public health experts, and officials who determined diagnostic needs and priorities in rural Cambodia during peak COVID-19 outbreaks. We analyzed geographic distances and transit times to testing in border provinces and assessed a high-risk province, Banteay Meanchey, where people crossed borders daily leading to disease spread. We strategized access to rapid antigen testing and molecular diagnostics in the aforementioned province and applied mobile-testing experience among the impacted population.
Results: COVID-19 outbreaks were difficult to manage in rural and isolated areas where diagnostics were insufficient to meet needs. The median transit time from border provinces (n=17) to testing sites was 73 (range 1-494) minutes, and in the high-risk Banteay Meanchey Province (n=9 districts), this transit time was 90 (range 10-150) minutes. Within border provinces, maximum versus minimum distances and access times for testing differed significantly (P<.001). Pareto plots revealed geospatial gaps in access to testing for people who are not centrally located. At the time of epidemic peaks in Southeast Asia, mathematical analyses showed that only one available rapid antigen test met the World Health Organization requirement of sensitivity >80%. We observed that in rural Solano and Yolo counties, California, vending machines and public libraries dispensing free COVID-19 test kits 24-7 improved public access to diagnostics. Mobile-testing vans equipped with COVID-19 antigen, reverse transcription polymerase chain reaction, and multiplex influenza A/B testing proved useful for differential diagnosis, public awareness, travel certifications, and telehealth treatment.
Conclusions: Rural diagnostic portals implemented in California demonstrated a feasible public health strategy for Cambodia. Automated dispensers and mobile POCT can respond to COVID-19 case surges and enhance preparedness. Point-of-need planning can enhance resilience and assure spatial justice. Public health assets should include higher-quality, lower-cost, readily accessible, and user-friendly POCT, such as self-testing for diagnosis, home molecular tests, distributed border detection for surveillance, and mobile diagnostics vans for quick telehealth treatment. High-risk settings will benefit from the synthesis of geospatially optimized POCT, automated 24-7 test access, and timely diagnosis of asymptomatic and symptomatic patients at points of need now, during new outbreaks, and in future pandemics.
Keywords: COVID-19; California; Cambodia; POCT; RAgT; SARS-CoV-2; Solano and Yolo counties; diagnostic portals; mobile-testing van and clinic; molecular diagnostics; point-of-care testing; public health resilience; rapid antigen test.
©Gerald Joseph Kost, Muyngim Eng, Amanullah Zadran. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 27.08.2024.
Conflict of interest statement
Conflicts of Interest: None declared.
Figures
Figure 1
Lockdowns, border crossing sites, and recommended COVID-19 testing locations during the peak epidemic in Cambodia with geospatial sites for international crossings and bilateral crossing gates. Provinces were locked down, and borders closed in Cambodia during COVID-19 surges from April to August 2021. Banteay Meanchey Province experienced high contagion caused by human border traffic to and from Thailand, which unilaterally shut down Poay Paet (Poipet) border crossings and stranded Cambodian migrant workers on the Thai side. Relatives who were out of work and who escaped Phnom Penh red-zone lockdowns returned home to villages and precipitated family outbreaks in rural Siem Reap Province, which was locked down.
Figure 2
A Pareto plot of distances and transit times to COVID-19 testing locations in Cambodian border provinces. The curve representing cumulative distance shows that Koh Kong Province nearly exceeds the Pareto 20% threshold and therefore, is most in need of locally available diagnostics. B: Battambang; BM: Banteay Meanchey; Kam: Kampot; Kan: Kandal; KK: Koh Kong; Kra: Kratié; M: Mondulkiri; O: Oddar Meanchey; P: Pailin; Pr: Prey Veng; Pu: Pursat; PV: Preah Vihear; R: Ratanakiri; ST: Stung Treng; Sv: Svay Rieng; T: Takeo; TK: Tboung Khmom.
Figure 3
Recommended geospatial sites for COVID-19 rapid antigen testing and mobile van testing in rural Banteay Meanchey Province during COVID-19 surges. KPP: Krong Paoy Paet; M: Malai; MB: Monkol Borei; OC: Ou Chrov; POCT: point-of-care testing; PNP: Preah Netr Preah; PS: Phnum Srok; SC: Svay Chek; SS: Serie Saophoan; TP: Thma Puok.
Figure 4
Pareto plot of distances and transit times to COVID-19 testing locations in the districts of Banteay Meanchey Province, which have high community populations and risk for COVID-19. KPP: Krong Paoy Paet; M: Malai; MB: Monkol Borei; OC: Ou Chrov; PNP: Preah Netr Preah; PS: Phnum Srok; SC: Svay Chek; SS: Serie Saophoan; TP: Thma Puok.
Figure 5
Mobile laboratory-POC strategies with telehealth implemented during the pandemic in rural Solano and Yolo counties of Northern California. The frames show the walk-up van, test popularity, and assay bench. For biosafety, molecular testing is cartridge based. The bottom right displays one of the several RAgT vending machines that anonymously issue free-of-cost test kits in Yolo County. The bottom left shows a mobile clinic for diagnostic-therapeutic (Dx-Rx) optimization, that is, COVID-19 diagnosis with Paxlovid or Molnupiravir treatment to care for patients with positive COVID-19 test results. Dx-Rx: diagnostic-therapeutic; NAAT: nucleic acid amplification test; POCT: point-of-care testing; PPE: personal protective equipment; RAgT: rapid antigen test.
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