Community Health Toolkit

New App Supporting CHWs administering COVID-19 Rapid Diagnostic Tests

In the past few days, the Medic Mobile team build a prototype COVID-19 RDT App for Community Health Workers. The current prototype is based on draft test procedures in Partners In Health’s Coronavirus response plan and documentation. This is an open-source app that could support CHWs administering an RDT for patients or themselves. Here’s the demo video (2 min 30 sec).

The prototype uses the workflow for the BioMedonics antibody (IgM/IgG) test, but we could quickly adapt for a different test. Before this is deployed, app builders will iterate based on the context. Documentation on our rationale and the app workflows can be found here; source code and images can be found in a public repository here.

We wanted to be prepared in case CHWs or other providers are administering RDTs. Our hope is that a tool like this could:

  • Help health workers stay safe
  • Improve quality of testing and care
  • Support updated testing and triage protocols as the context changes
  • Improve patient follow-up
  • Support patient education
  • Be reused and adapted as needed, integrated into existing apps and platforms

We’d appreciate input from you all. Do you have feedback on the tool or workflows? Where should we be prioritizing deployment?

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We wanted to share a bit about why the Medic Mobile prioritized the demo for the COVID-19 RDT App and the important of testing in the early phases of epidemic, particularly during the prevention, detection, and containment phases.

Why Testing?

Testing is one of the four components of PIH’s proposed COVID-19 response in LMICs, and we believe a digital tool to support CHW rapid diagnostic testing will enable CHWs to screen, identify, and provide care to community members impacted by COVID-19, as well as engage in contact tracing and other containment measures in early phases of the epidemic.

There are multiple types of tests available for COVID-19 and the CHT demo focuses on the use of the Antibody (lgM/lgG) rapid diagnostic test (RDT) . See the list below for more specifics on the three different types of tests available for diagnostic testing for COVID-19.

  • RT-PCR, short time window, takes days to run, requires lab facilities
  • Antibody (lgM/lgG) rapid diagnostic test (RDT), 3-5 day time window, takes 15min to run, can be done in the community
  • Antigen (Ag) rapid diagnostic test (RDT), 5-10 day time window, takes 15min to run, can be done in the community

Who should be tested?

The demo user is a CHW conducting a patient screening following a potential COVID-19 exposure. The intention of this workflow is that it is flexible enough to be adapted to multiple users, including patient assessments in the community and CHW self-assessments. Ultimately, the goal of rapid testing is to have a coherent community response that best utilizes CHWs across the different phases of the pandemic to save lives and stay safe. Please see the list below for more details on who should be tested.

  • Testing for contacts of people with documented COVID-19
  • Testing for inpatients and outpatients who meet the clinical case definition
  • Testing outreach for large gatherings
  • Testing for asymptomatic healthcare workers in high patient flow areas
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Very cool, thanks for sharing! A few questions:

  1. Question about symptoms. Just want to double-check if the intention is to get at if the patient is currently experiencing symptoms? And if no check boxes are checked, then this means the patient is not currently experiencing any symptoms?

  2. Given the 3-5 day window period (# days after symptoms first appear) where the patient may have negative IgM/IgG but still have COVID-19, it seems important to add a question asking when symptoms first started. And if the testing is being done within the window period, the CHW should probably be told it is not yet time to do the test and asked to repeat the test after the window period has passed.

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Thanks for the questions, Jane!

  1. Yes, the intention is to assess if the patient is currently experiencing symptoms - and if no check boxes are checked, then this means they are not experiencing symptoms following a potential COVID-19 exposure.

  2. Thanks for this suggestion! I’ve added it our collated feedback on this demo and we will incorporate it into a revision of the workflow.

Best,
Helen

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Thank you for sharing this demo. It looks great for the healthcare workers (HCW). Clear. Discrete tasks. Simple. Kudos! I see that you encourage the HCWs to have a COVID19 related conversation while the test is developing. Then, they see the results and clean up there workstation. I think there are a few things missing that would improve the form and workflow:

  1. Guidance on how to deliver these results. Maybe a sample script or some FAQs for the HCW to deliver the results and prepare a more detailed response on what the results mean for the patient. Or, is it assumed that the HCW would have this training?
  2. Will you remind the patient to bring things with them (health care, wallet, ID, phone, etc) in case they do not return promptly?
  3. Prompts to explain to the household (HH) members about how to clean up (laundry, soap/water, etc) in their HH as a precaution as the sick person leaves for confirmatory testing/potential confinement away from the HH.
  4. Counseling for the HH members on what to expect from the patient’s departure for the healthcare center. Any numbers to call or places to go for further information on their loved one as they potentially leave with this HCW?

I can imagine that giving these results to an individual in a HH will bring much fear, confusion, and potential negative reaction. What can be in the app to remind HCWs about these potential impacts upon results delivery and prepare them to answer questions or concerns?

Thanks for considering!
Caryl

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Thank you @cfeld for this feedback! I love the idea of a sample script for how to deliver results, as well as reminding patients to bring essentials with them to the health facility (if referred).

Including prompts for HH cleaning makes sense, could even be part of the CHW HH discussion during the 15min timer period.

Counseling for HH members is part of a broader conversation we are having at Medic around supporting patients and their families during the outbreak. Are there any resources you’ve seen around this that we could refer to?

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The app looks great and the workflow is very simple and user-friendly! Just a quick feedback:

  • Just like the instructions in the assessment result section to keep a safe distance with the patient, I believe it is equally important to keep that message on safe distancing in the Precautions step as well. Otherwise, there might be small dent in the message that would keep scope for spread or contamination during testing.
    Thanks!
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I am sorry that I dropped the ball here. Juggling too many moving parts. Thanks for considering those suggestions. I do not know how much further the conversation moved, but I can look for resources for the post-positive conversation if
you have not identified them. Sample script would be so helpful as you can imagine that the HCWs, themselves, might also search for words when faced with these diagnoses. I will try to pay closer attention to any marching orders. How can I help?

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Thank you so much for your interest in working with us! Any resources you’d like to point us to, we’d be happy to continue our work on this - and other priority use cases for COVID. A sample script would be great and we welcome continued thought partnership. Looking forward to hearing your thoughts and ideas!

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There are many pieces of advice out there, and your app can certainly handle many of them. I think that we are all looking at the CDC advice like this. But, I also went back to the HIV literature on giving test results (like these are great) but the main thing is that 80% of people (more or less) with COVID have only mild symptoms, so we don’t want the HCW to scare the person who tested positive. I think that the way that they calmly use that 15 minutes to prep the family/household for what to do would be key – riffing off the HIV results delivery and CDC advice. These would need to be adapted locally and quickly. Many of the suggestions are impossible in many of the places we work (isolation, no sharing, etc), so having a good local reality check will be critical. I also think that many countries are delivering results via phone or email with that usual caveat to get back in touch if they are having any of the more severe symptoms. As it become more normalized, I guess this will become easier too. Also, do we think that they HCWs will have masks? Will they be bringing one with them for the potential patients and HH?

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