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Lind ML, Schultes OL, Robertson AJ, Houde AJ, Cummings DA, Ko AI, Kennedy BS, Richeson RP. Testing Frequency Matters: An Evaluation of the Diagnostic Performance of a Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Rapid Antigen Test in US Correctional Facilities. Clin Infect Dis 2022; 76:e327-e335. [PMID: 35686341 PMCID: PMC9214176 DOI: 10.1093/cid/ciac450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Centers for Disease Control and Prevention recommends serial rapid antigen assay collection within congregate facilities. Although modeling and observational studies from communities and long-term care facilities have shown serial collection provides adequate sensitivity and specificity, the accuracy within correctional facilities remains unknown. METHODS Using Connecticut Department of Correction data from 21 November 2020 to 15 June 2021, we estimated the accuracy of a rapid assay, BinaxNOW (Abbott), under 3 collection strategies: single test collection and serial collection of 2 and 3 tests separated by 1-4 days. The sensitivity and specificity of the first (including single), second, and third serially collected BinaxNOW tests were estimated relative to RT-PCRs collected ≤1 day of the BinaxNOW test. The accuracy metrics of the testing strategies were then estimated as the sum (sensitivity) and product (specificity) of tests in each strategy. RESULTS Of the 13 112 residents who contributed ≥1 BinaxNOW test during the study period, 3825 contributed ≥1 RT-PCR paired BinaxNOW test. In relation to RT-PCR, the 3-rapid-antigen-test strategy had a sensitivity of 95.9% (95% CI: 93.6-97.5%) and specificity of 98.3% (95% CI: 96.7-99.1%). The sensitivities of the 2- and 1-rapid-antigen-test strategies were 88.8% and 66.8%, and the specificities were 98.5% and 99.4%, respectively. The sensitivity was higher among symptomatic residents and when RT-PCRs were collected before BinaxNOW tests. CONCLUSIONS We found serial antigen test collection resulted in high diagnostic accuracy. These findings support serial collection for outbreak investigation, screening, and when rapid detection is required (such as intakes or transfers).
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Affiliation(s)
- Margaret L. Lind
- Corresponding Author: Margaret L. Lind, PhD Yale University School of Public Health 60 College Street New Haven, CT 06510 United States of America
| | - Olivia L. Schultes
- Department of Epidemiology, University of Washington’s School of Public Health, Seattle, WA, USA
| | - Alexander J. Robertson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Amy J. Houde
- Connecticut Department of Correction, Wethersfield, CT, USA
| | - Derek A.T. Cummings
- Department of Biology, University of Florida, Gainesville, FL, USA,Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | | | | | - Robert P. Richeson
- Post Publication Corresponding Author: Robert P. Richeson, DC Connecticut Department of Corrections 24 Wolcott Hill Rd. Wethersfield, CT 06109 United States of America
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Schultes OL, Sikder M, Agyapong EA, Sodipo MO, Naumova EN, Kosinski KC, Kulinkina AV. Longitudinal borehole functionality in 15 rural Ghanaian towns from three groundwater quality clusters. BMC Res Notes 2022; 15:114. [PMID: 35317860 PMCID: PMC8939079 DOI: 10.1186/s13104-022-05998-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022] Open
Abstract
Objective In sub-Saharan Africa, 45% of the rural population uses boreholes (BHs). Despite recent gains in improved water access and coverage, parallel use of unimproved sources persists. Periodic infrastructure disrepair contributes to non-exclusive use of BHs. Our study describes functionality of BHs in 2014, 2015, and 2016 in 15 rural towns in the Eastern Region of Ghana sourced from three groundwater quality clusters (high iron, high salinity, and control). We also assess factors affecting cross-sectional and longitudinal functionality using logistic regression. Results BH functionality rates ranged between 81 and 87% and were similar across groundwater quality clusters. Of 51 BHs assessed in all three years, 34 (67%) were consistently functional and only 3 (6%) were consistently broken. There was a shift toward proactive payment for water over the course of the study in the control and high-salinity clusters. Payment mechanism, population served, presence of nearby alternative water sources, and groundwater quality cluster were not significant predictors of cross-sectional or longitudinal BH functionality. However, even in the high iron cluster, where water quality is poor and no structured payment mechanism for water exists, BHs are maintained, showing that they are important community resources.
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Affiliation(s)
- Olivia L Schultes
- School of Arts and Sciences, Tufts University, Medford, MA, USA.,University of Washington School of Public Health, Seattle, WA, USA
| | - Mustafa Sikder
- School of Engineering, Tufts University, Medford, MA, USA.,Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Michelle O Sodipo
- School of Arts and Sciences, Tufts University, Medford, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elena N Naumova
- School of Arts and Sciences, Tufts University, Medford, MA, USA.,School of Engineering, Tufts University, Medford, MA, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | - Alexandra V Kulinkina
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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Kulinkina AV, Sodipo MO, Schultes OL, Osei BG, Agyapong EA, Egorov AI, Naumova EN, Kosinski KC. Rural Ghanaian households are more likely to use alternative unimproved water sources when water from boreholes has undesirable organoleptic characteristics. Int J Hyg Environ Health 2020; 227:113514. [PMID: 32247226 DOI: 10.1016/j.ijheh.2020.113514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/06/2020] [Accepted: 03/19/2020] [Indexed: 11/24/2022]
Abstract
Sustainable Development Goal (SDG) 6 aims to achieve universal access to safe drinking water sources. However, the health benefits of meeting this goal will only be fully realized if improved sources are used to the exclusion of unimproved sources. Very little is known about how rural African households balance the use of improved and unimproved water sources when multiple options are present. We assessed parallel use of untreated surface water and unimproved hand-dug wells (HDWs) in the presence of boreholes (BHs) using a semi-quantitative water use survey among 750 residents of 15 rural Ghanaian communities, distributed across three BH water quality clusters: control, high salinity, and high iron. Multivariate mixed effects logistic regression models were used to assess the impact of water quality cluster on the use of BHs, HDWs, and surface water, controlling for distance to the nearest source of each type. Reported surface water use was significantly higher in the high salinity and high iron clusters than in the control cluster, especially for water-intensive activities. Respondents in the non-control clusters had approximately eight times higher odds of clothes washing with surface water (p < 0.01) than in the control. Respondents in the high salinity cluster also had 4.3 times higher odds of drinking surface water (p < 0.05). BH use was high in all clusters, but decreased substantially when distance to the nearest BH exceeded 300 m (OR = 0.17-0.25, p < 0.001). Water use from all sources was inversely correlated with distance, with the largest effect observed on HDW use in multivariate models (OR = 0.02, p < 0.001). Surface water and HDW use will likely continue despite the presence of BHs when perceived groundwater quality is poor and other water sources are in close proximity. It is essential to account for naturally-occurring but undesirable groundwater quality parameters in rural water planning to ensure that SDG 6 is met and health benefits are realized.
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Affiliation(s)
- Alexandra V Kulinkina
- Tufts University School of Engineering, Medford, MA, USA; Tufts University Friedman School of Nutrition Science and Policy, Boston, MA, USA.
| | | | | | - Bernard G Osei
- University College of Agriculture and Environmental Studies, Bunso, Eastern Region, Ghana
| | - Emmanuel A Agyapong
- University College of Agriculture and Environmental Studies, Bunso, Eastern Region, Ghana
| | | | - Elena N Naumova
- Tufts University School of Engineering, Medford, MA, USA; Tufts University Friedman School of Nutrition Science and Policy, Boston, MA, USA
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