Consecutive Evaluation of Systematic Community-Based COVID-19 Antigen Rapid Diagnostic Testing in Three Different Populations in Jamaica during the COVID-19 Pandemic

The rise in COVID-19 cases in late 2021 posed a grave threat to the public health system and the economy of Jamaica. A key pillar of controlling COVID-19 includes rapid diagnosis of SARS-CoV-2 infected individuals and their contacts. Hence, we evaluated the feasibility and acceptability of weekly deployment of antigen rapid diagnostic tests (Ag-RDTs) by conducting three 6-week studies within high-risk populations in Jamaica. We enrolled 1) 287 study participants (≥18 years) from low-income communities (Study A), 2) 262 healthcare workers (Study B), and 3) 88 students (14-17 years) (Study C). Conducting these independent studies was challenging. Willingness to participate was generally low with fear of phlebotomy (42%), discomfort associated with nasal swab (39%), and lack of parental consent (35%) being the most common reasons students gave (Study C) for lack of participation. Furthermore, only 57%, 66%, and 88% of participants concluded their final study visit in studies A to C, respectively. Participants' commitment and external factors, such as severe weather and outbreaks of violence affected follow-up. Overall, a total of six participants (<1%) tested COVID-19 Ag-RDT positive during all three studies, thus the number of infections detected were too low to draw any conclusions relating to the efficacy of the testing approach. Antibodies against SARS-CoV-2 were detected in most study participants (78-94%), but vaccination rates differed significantly between communities. Understanding these differences in vaccination rates is important because, given the low participation and follow-up rate, mass vaccination may present a more suitable public health intervention than regular testing.