{
  "abstract": "IntroductionLimited SARS-CoV-2 testing capacity during the early COVID-19 pandemic required approaches to identify individuals at highest risk of infection for prioritized testing. We assessed the association between symptoms and exposures reported at the time of SARS-CoV-2 testing and test positivity among individuals referred for testing through an interactive voice response (IVR) platform in refugee settlements in Uganda.\n\nMethodsWe used Dial-COVID, a multilingual, toll-free interactive voice response (IVR) platform to survey residents of refugee settlements in Uganda regarding COVID-19 symptoms, exposures, and comorbidities. Respondents reporting symptoms or exposures were invited for SARS-CoV-2 testing using nasal or oropharyngeal swab specimens. At the time of testing, an interviewer-administered questionnaire assessed symptoms and exposures occurring within the preceding two weeks. Log-binomial regression was used to identify factors associated with SARS-CoV-2 positivity.\n\nResultsBetween February 2021 and March 2022, 6,913 of 15,467 Dial-COVID callers (44.7%) completed the IVR survey. Among survey respondents, 5,184 (75.0%) reported at least one symptom or exposure. Of these, 1,361 (26.3%) were invited for testing, and samples were collected from 751 (55.2%) within seven days of survey completion. SARS-CoV-2 test results were available for 741 individuals, of whom 48 tested positive (6.5%). Among symptoms reported at the testing visit, severe muscle pain (risk ratio [RR] 2.08; 95% CI 1.20-3.57) and unusual fatigue (RR 2.34; 95% CI 1.36-4.03) were associated with SARS-CoV-2 positivity in unadjusted analyses. After adjustment for sex, refugee status, hypertension, and diabetes, only unusual fatigue remained independently associated with a positive test result (aRR 2.10, 95% CI 1.20- 3.67).\n\nConclusionFew self-reported symptoms were associated with SARS-CoV-2 positivity, highlighting the challenges of prioritizing testing based on symptoms alone. IVR-based platforms may provide a feasible approach for screening, surveillance, and linkage to testing in resource-constrained humanitarian settings.",
  "abstract_shown": true,
  "affiliations": [
    "Makerere University Infectious Diseases Institute"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "T. R. Muwonge"
    },
    {
      "name": "R. E. Klabbers"
    },
    {
      "name": "S. Ajidiru"
    },
    {
      "name": "P. Pham"
    },
    {
      "name": "P. Vinck"
    },
    {
      "name": "A. Mujugira"
    },
    {
      "name": "R. Nsubuga"
    },
    {
      "name": "M. Sharma"
    },
    {
      "name": "S. Borthakur"
    },
    {
      "name": "N. Mohammed"
    },
    {
      "name": "P. R. Ratanshi"
    },
    {
      "name": "C. Celum"
    },
    {
      "name": "K. N. OLaughlin"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bssqv3vwqfxbg.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.20.26365986",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.20.26365986v1.full",
  "id": "bssqv3vwqfxbg",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.20.26365986v1",
  "language": null,
  "licence": "CC0-1.0",
  "licence_label": "CC0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/publicdomain/zero/1.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "infectious diseases"
    ],
    [
      "openalex",
      "2611|COVID-19 epidemiological studies"
    ]
  ],
  "openalex": "W7223215568",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.20.26365986v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-20",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/bssqv3vwqfxbg.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:28Z",
      "native_id": "10.64898/2026.10.20.26365986",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.20.26365986v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:infectious diseases",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Associations with SARS-CoV-2 Positivity Among People in Refugee Settlements",
  "title_text": "Associations with SARS-CoV-2 Positivity Among People in Refugee Settlements",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:28Z",
  "url": "https://research.draconitic.com/paper/bssqv3vwqfxbg",
  "venue": "medRxiv",
  "versions": []
}