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Abstract
Objectives Globally, there is a lack of evidence regarding access to and utilisation of antigen rapid diagnostic tests (Ag-RDTs). This might hinder public health interventions to increase testing. We conducted a survey to understand access to and utilisation of COVID-19 Ag-RDT among residents in Phnom Penh, Cambodia.
Design This is a representative household survey using linear regression models with random effects to account for clustering and a logistic model with random effects to assess factors associated with Ag-RDT access.
Setting We conducted the study in 10 villages in Phnom Penh between August and mid-September 2022.
Participants We enrolled one member per household (n=280), aged between 18 and 65 years.
Outcome measures Both access and utilisation were defined at the individual level (self-reports). We defined access as having undergone COVID-19 rapid testing within 6 months and utilisation as having administered this test (to themselves or others) within 12 months, prior to the study interview.
Results In a clustering-adjusted linear model, access to Ag-RDTs among the general population from the 10 villages was 34% (n=95) and utilisation was 28% (n=77). Price and advice from the pharmacist were commonly reported to be the main selection criteria for Ag-RDTs, with 41% (n=111) and 62% (n=175), respectively. In the logistic model, those with higher educational attainment were more likely to have access to the Ag-RDT compared with those with lower education levels (adjusted OR4.42, 95% CI 1.82 to 10.74).
Conclusions Unfamiliarity with Ag-RDT tests and low education levels negatively affect access and utilisation of Ag-RDTs among the general population in Phnom Penh.
- EPIDEMIOLOGY
- EPIDEMIOLOGIC STUDIES
- Behavior
- PUBLIC HEALTH
- COVID-19
Data availability statement
Data are available upon reasonable request. Upon reasonable request, data could be requested through the corresponding author.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Strengths and limitations of this study
With zero refusals and a very small number of replacement households, chances of selection bias due to differential participation by demographic factors are highly unlikely in this study.
Assessment of the main outcomes and other variables was based on self-reports, potentially leading to biased estimates.
The study results might have limited generalisability, particularly among individuals residing outside of Phnom Penh and due to changing public health responses to COVID-19 over the course of the pandemic.
Introduction
Since early 2020, when the first case of COVID-19 was reported in Cambodia,1 various diagnostic technologies have played important roles in quickly identifying cases for timely public health measures. Since their formal introduction into the Cambodian market around July–August 2021, antigen rapid diagnostic tests (Ag-RDTs) quickly became essential point-of-care tests as screening tools in healthcare facilities and by the general public in the privacy of their homes.
Compared with PCR tests, which remain the gold standard for diagnosing clinical COVID-19 infection, Ag-RDTs are cheap, portable and easy to administer and have excellent accuracy for rapidly identifying both symptomatic individuals and asymptomatic individuals with high viral loads,2 3 so that they may self-isolate, thereby interrupting chains of transmission. COVID-19 testing has been essential since the early stages of the pandemic, not only for diagnostic purposes but also for resuming many activities within countries and across borders (eg, international travel and economic activities). As the pandemic continued, the ability to develop and adapt responses increasingly depended on the availability of rapid testing and diagnostic strategies.4 5 In Cambodia, PCR tests had been used for all inbound travellers since the start of the pandemic free of charge until July 2022, when the Ministry of Health (MoH) decided to exempt from quarantine for inbound unvaccinated or not fully vaccinated travellers, but they were required to take a rapid antigen COVID-19 test on arrival.6 Several Ag-RDTs had been approved for use7 and been made available widely on the market for purchase without prescription. They were mainly used for screening purposes, free of charge, at public hospitals, certain enterprises/institutions and at other public entry ports like airports, official events, etc. At private clinics or hospitals, a negative rapid test result was required before consultation or hospitalisation, and in general, testing was provided at a cost. The price of Ag-RDTs varied from around US$1–10 per test. Despite their importance in the efficient and early detection of COVID-19-infected individuals,8 no study had been conducted at that time to understand the access to and utilisation of Ag-RDTs in Cambodia. Past studies conducted in the region focused more on PCR testing and associated factors.9 10 We conducted our study in Cambodia’s capital city, Phnom Penh (figure 1). It is home to more than 2 million people and, compared with other provinces, is where the largest proportion of the Cambodian population resides11 12 (figure 1). Given the heightened risk of transmission in more densely populated settings,11 13–15 we focused our investigation on Phnom Penh to help inform improving rapid test uptake and access rates among Phnom Penh residents, including timely diagnostic and linkage to treatment of certain subgroups who might be at higher risk of COVID-19-related morbidity and mortality, such as the elderly or people with important comorbidities. In this context, we conducted the present household-level study to determine the access to and utilisation of Ag-RDTs among the general population living in Phnom Penh in 2022.
Geographic location of Phnom Penh.
Methods
Study design and contexts
This is a representative household-level survey conducted among 280 household members residing in 10 villages in Phnom Penh from mid-August to September 2022. For context, Phnom Penh is administratively divided into districts, subdistricts and villages, which are the smallest geographic unit. There is, in general, no fixed number of households in a village; the village size could therefore vary greatly in terms of household numbers.
Study population
The participants aged between 18 and 65 years were recruited through a multistage sampling process. We included only adults up to 65 years based on the assumption that those above that age are highly unlikely to use the Ag-RDT (retirement age in Cambodia) but more likely to stay home during the time of the survey, which makes including them highly likely without the age restriction. In the first stage, the list of all villages in the Phnom Penh area and the corresponding number of families in each village were obtained from the latest Cambodian census (2019). We then selected 10 villages using probability-proportional-to-size (PPS) sampling out of the total 956 villages in Phnom Penh. With PPS, each village had an assigned number of households to be recruited determined by their actual size (see online supplemental table 1 for details). In the second stage, we obtained an up-to-date list of all households/families within each selected village. Using a random number table (integrated into the Open Data Kit or ODK-based application on the tablet used for data collection), the study team then randomly selected the required number of households from each of those villages. In the third and final stage, only one of the eligible household members was randomly selected to participate in the survey. The selection process here is similar to that of selecting households.
Supplemental material
We defined access as having undergone Ag-RDT for COVID-19 within the past 6 months of the interview date and described where they had undergone the testing. Utilisation was defined as having administered the Ag-RDT either to oneself or to others within the past 12 months. This information collected was based on self-report.
The sample size was calculated based on the assumption that the Ag-RDT access in Cambodia was 30%, using the formula in which precision is used for sample size estimation: 
, where P is the estimated proportion and d is the targeted precision level (∼6% in our study); the final sample size was then calculated by multiplying the sample size n with design effect (deff), estimated based on the formula 
, where ρ is the intraclass correlation (ICC). The ICC value of 0.01 had been chosen based on previous household seroprevalence surveys conducted in Cambodia and other studies.16 17 Participant inclusion criteria were being aged between 18 and 65 years, residing within the selected household for at least 3 months prior to the survey date and provided informed consent.
Data collection processes
Prior to survey administration, the data collectors underwent training on how to obtain verbal informed consent and how to use tablets to collect/record information from study participants via computer-assisted personal interviewing (CAPI). All data collectors underwent training with human subjects certified trainers.
Information collected from each selected household member for the survey included demographic characteristics, access and utilisation of Ag-RDTs (via CAPI) using tablets. At each selected village, the study team went to each selected household with designated village volunteers to meet the household members. If the selected household member was not home at the time of the survey administration, the study team left the study information sheet with the other present household members, took the selected member’s contact information and called them to explain the study and arranged for another meeting with them at a later date. Of note, none of the participants who had been called back for the survey refused to participate; therefore, no replacement had to be made. Households, where none of the members were present (approximately five houses), were systematically replaced (the data collectors were trained to replace these households with the nearest household located on the right side of the original selected household). The interview took place inside the interviewee’s home, in general, although sometimes this also happened within the house vicinity where seating arrangement was more convenient for everyone.
Analysis
The study participants’ de-identified data were stored on the University of Health Sciences’s server, with access being restricted to only the designated study’s data personnel and team.
Means and SD were calculated for continuous variables (normality checked) and proportions and percentages for categorical variables. We fitted a linear model in univariate analysis and reported on these proportions and percentages for each categorical variable, using a mixed-effects model to account for variability between clusters at the village level. Similarly, for the logistic mixed-effects model, we modelled Ag-RDT access as a function of demographic factors and reported crude and adjusted ORs from the mixed-effects model, accounting for clustering and potential confounding variables, which we selected based on prior knowledge and literature review.18 All analyses were conducted using STATA V.17 (Copyright 1985–2021 StataCorp, Texas, USA).
Patient and public involvement
Household members, village authorities and volunteers had been involved in the data collection of the study. Preliminary results of the study were presented in Phnom Penh in November 2022, with village volunteers and chiefs, high-level representatives and guests from the MoH, students from the University of Health Sciences and relevant partner organisations and researchers in attendance.
Results
Demographics
We approached 285 households and collected information from 280 household members residing in the 10 selected villages in the Phnom Penh area. There were five households with no occupants during the study visits, and we could not obtain any information about the household, so they were replaced. Overall, we found 34% (n=95) and 27% (n=77) of respondents reported having accessed and used Ag-RDT. We presented in table 1 the access and utilisation among the study participants by selected demographic characteristics. About 32% (n=89) of the study volunteers in our survey were men, and the mean age was 40 years (SD 13). About 37% (n=105) of our study volunteers had completed high school or higher educational degrees. Most of them worked in service and sales, 43% (n=121) and only about 8% (n=23) were unemployed or students.
Access and utilisation by selected demographics among study participants (n=280), Foundation for Innovative New Diagnostics Accelerator Project, 2022, Cambodia
Among the 89 male study participants, 40% (n=36) reported having recent access to Ag-RDT and among women (n=191), only 32% (n=59) of them reported having access to Ag-RDT. Similarly for utilisation, more men (34% or n=31) reported the utilisation of the Ag-RDT compared with women (25% or n=46). We also observed that the number of study participants in the oldest age group reported the lowest rates of both Ag-RDT access and utilisation (24% and 10%, respectively) compared with the younger age groups, where both access and utilisation rates ranged from 30% to 40%. Study participants who reported the highest access and utilisation rates were those who had completed high school or higher in terms of education (around 48%–49%), whereas those who had none to less than primary education reported the lowest rates of access and utilisation (21% and 5%, respectively).
Access to Ag-RDT
Although all of the study participants reported having heard of Ag-RDTs, only 34.5% (n=95) had access to these rapid tests (table 2).
Access to and utilisation of COVID-19 Ag-RDT among study participants (n=280), Foundation for Innovative New Diagnostics Accelerator Project, 2022, Cambodia
The majority of study participants (64% or n=175) knew of Ag-RDT from social network platforms, such as Facebook, followed by families and friends, with 54% (n=149) and 41% (n=116), respectively. A substantial number of our interviewees also knew Ag-RDT from watching television (39% or n=108).
About 25% (n=70) of the study participants reported that they had obtained some Ag-RDT free of charge within the past 12 months, and almost everyone who had done so (n=63) agreed that it was quite easy to obtain them without payment. Additionally, we observed that most of them obtained the Ag-RDT for free from their workplace (n=29) and from local authorities (n=21). Besides obtaining these rapid tests for free, some also bought these tests for use (n=101), and among them, 88% (n=88) agreed that buying these Ag-RDTs was, in fact, easy. We also found that the majority of our study participants who actually obtained the Ag-RDT for free (n=29) actually used these tests before entering events and places and not for symptom-based testing. Also, it is important to note that about 90% of study participants agreed that obtaining Ag-RDTs for free was, in fact, easy, which implies that the cost of rapid tests might not play an important role, as they could easily get these tests free of charge.
Utilisation of Ag-RDT
About 28% (n=77) had administered the Ag-RDT to themselves or others within the past 12 months. Among these, 12% (n=32) reported being familiar with administering these rapid tests to themselves as well as to others. The majority of participants reported that they would use rapid tests if they or their families had suspected symptoms or had been exposed (97% or n=273). When asked to describe the next steps if their rapid test result was to return positive, a large proportion of our study participants reported that they would seek advice from public healthcare providers (46% or n=134). Finally, the study participants were also asked to define their selection criteria for the COVID-19 rapid tests, and the majority of them reported that price (41% or n=111) and recommendation from a pharmacist (62% or n=175) were their main criteria for selecting an RDT. More details on access and utilisation can be found in table 2.
Factors associated with Ag-RDT access
In both crude and adjusted mixed-effect logistic models, only education and occupation appeared to be associated with Ag-RDT access (table 3).
Factors associated with Ag-RDT access among study participants (n=280), Foundation for Innovative New Diagnostics Accelerator Project, 2022, Cambodia
Those who received higher education (completed high school degrees or higher) were more likely to have access to the Ag-RDT compared with those who had none or less than primary education (OR 7.44, 95% CI 3.73 to 14.8 and aOR 4.42, 95% CI 1.82 to 10.74), in the crude and adjusted logistic mixed models, respectively. Furthermore, compared with those who worked in the government and military, other occupations, such as those who work in sales/services or housewives, appeared to be likely to have access to Ag-RDT testing within the past 6 months (aOR 0.14, 95% CI 0.04 to 0.45 and aOR 0.17, 95% CI 0.06, to 0.50), in the case of sale/service work and housewives, respectively. Those in the oldest age group (48 years and above) appeared to be less likely to have had access to Ag-RDT compared with those in the youngest age group (18–27 years) (OR 0.48, 95% CI 0.22 to 1.05). However, in the adjusted mixed-effects model, the association disappeared (aOR 0.69, 95% CI 0.27 to 1.78). Similarly, the access to Ag-RDT did not appear to differ by sex, both in the crude and adjusted models (OR 0.66, 95% CI 0.39 to 1.13 and aOR 1.19, 95% CI 0.62 to 2.29). Upon observing a suboptimal rate of access (34%), we did not extend the same analysis for utilisation; we reasoned that low utilisation was most likely due to low access. It should be noted that because the cost of Ag-RDTs was not associated with access or education (results not shown) and obtaining free rapid tests was easy for the majority of participants, the variable on test cost was not entered into the model.
Discussion
This was the first study to examine access to and utilisation of Ag-RDTs for COVID-19 among the general population in Cambodia, and quite possibly in Southeast Asia, since most studies focused on PCR testing. We found rates of access and utilisation among the study at 34.5% and 28%, respectively, and they seemed to differ by occupation and educational levels. For context, new cases of COVID-19 in Cambodia started decreasing in the 6–8 months prior to our study—from about 400 new cases reported in early 2022 (8 months prior to the survey) to around 100 in early July 2022 (1 month prior to the survey),6 19 after which date the MoH and Inter-Ministerial Committee to Combat COVID-19 in Cambodia started implementing the Operational Guidelines for Use of COVID-19 Ag-RDTs for Private Health Providers, Non-health Government Institution-Entities, Points of Entry, Private Companies, Factories-Enterprises and other Business Locations and individuals.20 Since issuing these guidelines, most public institutions (ministries, hospitals, etc) provided free testing or test kits to their employees, which could explain the relatively high testing rates among government staffs in our results. Others set up their own rules for testing their employees/clients using the operational guidelines as guidance to ensure the safety of the working environment, such as testing before entering public gatherings or events or testing every other day for those working in delivery service. At the time of the study’s conduct, medical prescription was not required for COVID-19 testing (PCR or Ag-RDT), and most hospitals and testing centres offered them at no charge. However, in most private settings, the PCR tests for COVID-19 might cost about 6–10 times higher than the Ag-RDT, depending on the provider.
Access to Ag-RDTs
There had been several publications from the UK looking at COVID-19 testing access prior to our study. A research article published in 2022 examining motivations of individuals seeking COVID-19 rapid tests at community testing centres in two areas in England reported that about 35% of their study population had heard of rapid testing centres from their work, 8% from local authorities, 11% from Facebook and television.2 These findings were similar to ours in that about 10% of our study participants heard of Ag-RDT from local authorities. However, we found much lower proportions of people who reported having heard of rapid tests from their workplace but higher proportions of those who reported having heard of rapid tests from social networks and television, at 64% and 39%, respectively. It is noteworthy that the study populations in both studies were very different. While the study population in the UK comprised employees in education, essential work and health,2 the majority of household members in our study were in sales/services as an occupation. Therefore, in the UK study, many might know about rapid testing from their workplace. Moreover, in Cambodia, social network platforms, such as Facebook, and the internet are highly popular21 22; therefore, many more respondents were likely to hear of rapid tests from the internet and social pages in Cambodia. Access to Ag-RDT was higher among men in our study, but the opposite had been reported in two other studies.23 24 Regardless, in our adjusted regression model, sex is not significantly associated with access to Ag-RDT; potentially this was due to our much smaller sample size compared with the two studies.
Utilisation of Ag-RDTs
According to the Morbidity and Mortality Weekly Report (MMWR) issued in March last year, about 11% of their online survey respondents reported at-home rapid antigen COVID-19 test utilisation over the past 30 days.25 We reported a 12% utilisation rate over the past 12 months. Although we did not show it, the numbers reported for the past month were also roughly the same in our study, as Cambodia started to see a significant decrease in COVID-19 cases from June to July 2022 (1–2 months prior to the survey). In their report, among those who did the rapid tests at home, 29% reported that they did the test because they had COVID-19 symptoms,25 which is much higher than what was reported in our study (only about 16% of our study participants reported using their last free rapid test for symptom-based testing). Similarly, a French study also reported the majority of their study participants underwent self-testing due to the apparition of COVID-19 symptoms.26 This difference is more likely due to the fact that the majority of our study participants actually underwent the last rapid test at the point of entry (a common requirement before either entering an event or a place in Cambodia during the time of the study) and not necessarily because they had COVID-19-related symptoms. In addition, both the American (MMWR) and French studies focused more on self-testing utilisation while ours also covered the use of Ag-RDTs on and by others. Another factor affecting the use of Ag-RDT is the test kit cost, which had been identified in a qualitative study conducted in the US as well as in a Chinese survey in 202227 28 as one of the main concerns of respondents. This is also in line with our findings, where about 36% of participants reported that the price of the Ag-RDT was expensive for them. The 2022 Chinese study27 also reported that education level was positively associated with higher utilisation (or intent to utilisation), which is also consistent with our study results. This might be due to the working status of those with high education, which requires them to travel and join events more often than those with lower educational backgrounds. Also worth highlighting was the high proportion of respondents who reported that their choice of the Ag-RDT depended on the recommendation from the pharmacists. In Cambodia, according to past studies, the majority of Cambodians seek care from the private sector (including private hospitals, clinics, pharmacies, etc),29 30 and because prescriptions are not generally required for getting medication at pharmacies,31 the pharmacists are usually where people go first for their minor health problems or questions, although the roles of pharmacists in the Cambodian health system have yet to be studied in detail.
It is important to note that study sites were very diverse in terms of their population composition and socioeconomic status and included sites in central Phnom Penh and in the suburban parts of the capital city (figure 2). While our study population was broadly representative of the wider Phnom Penh area as a whole, caution should be taken when attempting to generalise our findings to populations residing outside of Phnom Penh. It is also important to note that the testing uptake, access and utilisation might have changed substantially after the study had been conducted, as the pandemic and subsequently, the response evolved. Second, our study had a low proportion of male participants compared with females (one-third), which might also limit the study’s generalisability. Regardless, this is a common finding for household surveys in Cambodia; the latest Cambodia Demographic and Health Survey also had a similar proportion of male respondents.32 In addition, we already observed that the testing access was not different among men and women in our study. Third, we were not able to conduct a comprehensive assessment of the socioeconomic status of the selected households, as asking people about their income is usually considered impolite in Cambodia. However, we did include complementary questions on the education and occupations of each selected member, which are also useful proxy indicators for a person’s economic status. Although this is not a reflection of the household status as a whole, it reflects the individual’s ability to afford the test in general, which was the main research question. Finally, we asked our study participants to recall over a period of 12 months their practices regarding rapid testing for COVID-19, which is a considerable amount of time for recall. However, administering rapid tests during the pandemic is rather memorable as an event, and Cambodia had only started to really feel the effect of the COVID-19 pandemic starting in 2021, when mass testing and other public health measures, including travel bans and physical and social measures, were beginning to really take off. There were also several major pandemic-related events as reference points of timeframe to help the study participants better recall their testing practices. Additionally, there were many pictures for memory aid that had been integrated into the e-questionnaires, helping participants with their recall. Despite these limitations, our study also presented several strengths. Our work is the first one to examine testing access and utilisation among the general population in the country. In addition, our study had zero refusals, zero household members who needed to be replaced (due to their absence at the time of data collection) and very limited numbers of households (around five households) that actually had to be (systematically) replaced. This suggests that a selection bias due to differential participation rates across various demographic profiles and geography is highly unlikely in our survey.
Geographic distribution of the 10 selected subdistricts (Sangkat) in Phnom Penh.
The Ag-RDTs is one of the important public health tools for fighting the COVID-19 pandemic, as it is simple to use, can provide rapid results and has been proven to detect almost all of the persons with high viral loads, who are at the greatest risk of transmitting the virus.33
Implications for policy and practices
Although access to and utilisation of COVID-19 Ag-RDTs have been studied elsewhere, there are country-specific contexts that are helpful to understand when developing strategies for improving testing uptake and utilisation; for example, the public trust in the pharmacists when choosing the rapid tests that were reported in our study or the fact that many people used the tests but only because they were required for entry (at an event or place). The effective intervention needs to take into account these contextual factors that vary from one country to another and from one population to another to ensure the successful delivery of the intervention. Several factors could affect the utilisation of Ag-RDTs, and one important factor is the low access to these rapid tests, which could be due to the costs of these tests and how easy (or difficult) it is to administer the test. In Cambodia, pharmacists are, in general, the first people from whom advice is sought over minor health-related issues, and this fact remained true in the pandemic context, as demonstrated in our study findings. This highlights the important role that health professionals in the private health sector, such as pharmacies and clinics, could play in getting correct information directly to the general public and where applying self-administered public health measures is feasible, especially during a public health crisis. In addition, we also saw how village authorities and volunteers worked to support the health sector to curb the spread of COVID-19 through sharing information on testing points with individuals in the communities as well as helping them get access to these rapid tests when they are needed. This is, of course, of particular importance in the event of lockdown measures, where entries to and exits from affected communities are restricted. Other than these, friends, neighbours and workplace could potentially be additional and crucial sources of information, support and distribution points of public health interventions, which include (but are not limited to) rapid screening tests.
Conclusions
Lack of access to and utilisation of simple screening tools such as Ag-RDTs could certainly hinder the control of the disease transmission and subsequently the pandemic. Although there are reported limitations to the COVID-19 Ag-RDTs regarding their accuracy (compared with the molecular testing methods), their ability to screen infected individuals with high viraemia and provide rapid results remains undoubtedly one of the most important public health tools in the pandemic response. Ensuring equity in access and uptake of rapid diagnostic tools in the general population is crucial for everyone so that they can protect themselves as well as seek appropriate treatment and support in a timely manner. Multiple factors could affect rapid test access and utilisation among individuals, including, among others, education and suggestions from pharmacists.
Data availability statement
Data are available upon reasonable request. Upon reasonable request, data could be requested through the corresponding author.
Ethics statements
Patient consent for publication
Ethics approval
The current study was approved by the Human Research Ethics Committee of the University of New South Wales (HC220035) and the National Ethics Committee for Health Research in Cambodia (NECHR #112) in 2022. No identifying information were collected and all study participants provided verbal informed consent according to the approved study protocols (waiver of written consent approved by both ethics committees).
Acknowledgments
We would like to acknowledge the study sponsor, the Foundation for Innovative Diagnostics (FIND) and our partners at the Kirby Institute/University of New South Wales for their support throughout the course of this work. We would like to also acknowledge the FIND program manager, Kirsten Ridley, for her enthusiastic and efficient coordination and flexibility in the overall management of this incredible collaborative work as well as the STATS department at the University of New South Wales (UNSW) for their technical support in sample size estimation. Lastly, we would like to acknowledge our local authorities and village volunteers from the 10 selected villages, 10 subdistrict (Sangkat) and nine districts (Khan) for their support during the whole data collection period with the study team.
Footnotes
JK, AJV and VS are joint senior authors.
X @kennareyseang
Contributors KS conducted literature search, designed the study, collected and analysed the data, interpreted results, wrote the manuscript and created figures. FV conducted literature search, designed the study and guided data analysis and interpretation. SK and VO conducted literature search and collected the data. JK, AJV and VS conceptualised the study idea, conducted literature search and guided data collection, analysis and result interpretation. All authors provided critical feedback and shaped the final manuscript. All authors have read and agreed to the published version of the manuscript. KS is responsible for the overall content as guarantor.
Funding Support for this project was provided through funding from the Foundation for Innovative New Diagnostics (FIND), as part of the accelerating uptake of COVID-19 Ag RDTs in the Indo-Pacific programme. The programme was delivered in 2022 as a collaborative effort between Kirby Institute at UNSW Sydney, Australia (Grant No. RG212766), the Burnet Institute, the Doherty Institute at the University of Melbourne, the Clinton Health Access Initiative, The Foundation for Innovative New Diagnostics of Geneva, Switzerland, and our partners in Indonesia, Cambodia, PNG and Lao PDR. The views expressed by the authors do not necessarily reflect the views of the funding agency.
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Competing interests KS, FV, SK, VO, JK, AJV and VS received funding from the Foundation for Innovative New Diagnostics (FIND) to conduct this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
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