Nearly 2.9 million people in this area comprise internally displaced populations (IDPs) due to war. North-west Syria (NWS), with a population of 4.6 million, is one of the world’s most politically unstable geographical areas. Therefore, it is likely that the number of people infected and deaths due to COVID-19 were higher than reported. This has resulted in refugees and migrants experiencing disproportionately limited access to COVID-19 testing. The pandemic led to a considerable burden on the health systems of MENA countries that cater to refugees and migrants, leading to inadequate diagnostic testing. The Middle East and North Africa (MENA) countries experienced high morbidity and mortality during the COVID-19 pandemic, with more than 18 million individuals infected and over 750,000 deaths. Embedding Ag-RDTs into COVID-19 testing and screening strategies would be highly beneficial. Ag-RDTs represent a feasible screening/diagnostic tool for COVID-19 infections in NWS, with nearly 90% uptake. Challenges included obtaining informed consent and conducting confirmatory testing. Observed sensitivity, specificity, and positive and negative predictive values were 80.0%, 96.1%, 91.4%, and 90.3%, respectively. A non-random sample of 236 individuals underwent confirmatory RT-PCR testing. The highest positivity was observed among those with severe COVID-19 symptoms (12.7%), with respiratory illnesses (2.5%), enrolled at hospitals in Afrin (2.5%), and healthcare workers (1.9%). In total, 27,888 eligible individuals were enrolled, 24,956 (89.5%) consented to test, and 121 (0.5%) were COVID-19-positive. A local non-governmental organization implemented 25,000 Ag-RDTs that were conducted cross-border by trained community health workers. A cross-sectional study design involving secondary analysis of data collected during the project was employed. A pilot project was implemented to introduce Ag-RDTs in NWS, aiming to determine the feasibility, uptake, and results of Ag-RDTs and identify facilitators and barriers to testing with Ag-RDTs. COVID-19 antigen rapid diagnostic tests (Ag-RDTs) have the potential to overcome this barrier. Due to its limited health infrastructure, accessing advanced COVID-19 testing services is challenging. North-west Syria (NWS) is a conflict-affected and unstable area.
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