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

Aims: We 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. Methods: Participants 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>7.0; random>11.1mmol/L) and/or BP (diastolic>90 and systolic>140mmHg) were referred to their clinic and phoned to confirm linkage. Results: 1169 participants were enrolled and screened for diabetes and hypertension. Combining participants with a previous diagnosis of diabetes (n=23, 2%; 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 31.7% of those with elevated BG and 16.0% of those with elevated BP linked-to-care. Conclusion: By opportunistically leveraging existing COVID-19 screening in South Africa to screen for diabetes and hypertension, 24% 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.The Foundation for Innovative New Diagnostics (FIND) and the National Institute of Diabetes and Digestive and Kidney (NIDDK) grant 1K01DK116929-01A1