Integration of point-of-care screening for type 2 diabetes mellitus and hypertension with COVID-19 rapid antigen screening in Johannesburg, South Africa

AimsWe sought to evaluate the yield and linkage-to-care for diabetes and hypertension screening alongside a study assessing the use of rapid antigen tests for COVID-19 in taxi ranks in Johannesburg, South Africa. MethodsParticipants were recruited from Germiston taxi rank. We recorded results of blood glucose (BG), blood pressure (BP), waist circumference, smoking status, height, and weight. Participants who had elevated BG (fasting & GE;7.0; random & GE;11.1mmol/L) and/or BP (diastolic & GE;90 and systolic & GE;140mmHg) were referred to their clinic and phoned to confirm linkage. Results1169 participants were enrolled and screened for elevated BG and elevated BP. Combining participants with a previous diagnosis of diabetes (n = 23, 2.0%; 95% CI:1.3-2.9%) and those that had an elevated BG measurement (n = 60, 5.2%; 95% CI:4.1-6.6%) at study enrollment, we estimated an overall indicative prevalence of diabetes of 7.1% (95% CI:5.7-8.7%). When combining those with known hypertension at study enrollment (n = 124, 10.6%; 95% CI:8.9-12.5%) and those with elevated BP (n = 202; 17.3%; 95% CI:15.2-19.5%), we get an overall prevalence of hypertension of 27.9% (95% CI:25.4-30.1%). Only 30.0% of those with elevated BG and 16.3% of those with elevated BP linked-to-care. ConclusionBy opportunistically leveraging existing COVID-19 screening in South Africa to screen for diabetes and hypertension, 22% of participants received a potential new diagnosis. We had poor linkage-to-care following screening. Future research should evaluate options for improving linkage-to-care, and evaluate the large-scale feasibility of this simple screening tool.

Automated summary

By utilizing COVID-19 screening as an opportunity, we assessed the yield and linkage-to-care for diabetes and hypertension screening in taxi ranks in Johannesburg, South Africa. The overall indicative prevalence of diabetes was estimated to be 7.1%, and hypertension was estimated to have a prevalence of 27.9%. However, the linkage-to-care following screening was poor, with only 30% of individuals with elevated blood glucose and 16.3% with elevated blood pressure seeking medical attention.