Experiences of community-based health workers with COVID-19 rapid diagnostic testing after training in Abuja, Nigeria, 2022-2023

Introduction: Professional-use COVID-19 antigen-rapid diagnostic tests (SARS-CoV-2 Ag-RDT) are used in Nigeria to scale-up testing into novel settings (community pharmacies and patent medicine stores). The theoretical domain frameworkposits that providers need knowledge, self-efficacy, belief in and motivation to adopt Ag-RDT. Additionally, it is crucial to understand the environmental context, including the demand, acceptability, and barriers associated with the implementation of a novel healthcare program. This study aimed to present insights on these domains for pharmacists and patent medicine vendors, and primary healthcare workers delivering COVID-19 Ag-RDT following the training of providers in Nigeria. Methods: Funded by Unitaid through the Self-testing COVID Project, researchers designed a quantitative tool to assess the domains of belief, perception and knowledge administered, demand, and barriers among 116 providers: 73 primary healthcare workers, 31 community pharmacists, and 12 patent medicine vendors between September 2022 and January 2023. Results: Across all healthcare provider categories, knowledge and self-efficacy regarding COVID-19 Ag-RDT were notably high. Nearly all community pharmacists (97%, 30/31) and all primary health center workers (100%, 73/73) reported experience with rapid diagnostics for other health conditions, compared to 75% (9/12) of patent medicine vendors. Performing Ag-RDT was perceived as easy by all pharmacists and PHC workers, versus 92% (11/12) of PMVs. Regarding the adequacy of clinical symptoms for diagnosing COVID-19, 55% (6/12) of PMVs disagreed, a smaller proportion than pharmacists (75%, 21/31) and PHC workers (75%, 53/73). Confidence in interpreting RDT results was lowest among PMVs (17%, 2/12), compared to pharmacists (35%, 11/31) and PHC workers (30%, 22/73). Educational background varied, with all pharmacists and PHC workers holding tertiary degrees, compared to only 33% (4/12) of PMVs. Additionally, 84% (26/31) of pharmacists and 70% (51/73) of PHC workers reported well-equipped facilities, versus 58% (7/12) of PMVs. Conclusion: Novel settings for COVID-19 Ag-RDTs depend on healthcare providers’ knowledge and perceptions. Better knowledge and perceptions are observed in higher-qualified healthcare centers, with greater demand primarily in public sector facilities such as primary health centers. Patent medicine vendors and pharmacists may benefit from enhanced support when implementing novel services, such as community-delivered COVID-19 testing.