Associations with SARS-CoV-2 Positivity Among People in Refugee Settlements
- 1Makerere University Infectious Diseases Institute
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.
MethodsWe 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.
ResultsBetween 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).
ConclusionFew 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.
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BibTeX
@misc{muwonge2026associations,
title = {{Associations with SARS-CoV-2 Positivity Among People in Refugee Settlements}},
author = {T. R. Muwonge and R. E. Klabbers and S. Ajidiru and P. Pham and P. Vinck and A. Mujugira and R. Nsubuga and M. Sharma and S. Borthakur and N. Mohammed and P. R. Ratanshi and C. Celum and K. N. OLaughlin},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.20.26365986},
url = {https://www.medrxiv.org/content/10.64898/2026.10.20.26365986v1},
note = {CC0},
}
RIS
TY - UNPB
TI - Associations with SARS-CoV-2 Positivity Among People in Refugee Settlements
AU - T. R. Muwonge
AU - R. E. Klabbers
AU - S. Ajidiru
AU - P. Pham
AU - P. Vinck
AU - A. Mujugira
AU - R. Nsubuga
AU - M. Sharma
AU - S. Borthakur
AU - N. Mohammed
AU - P. R. Ratanshi
AU - C. Celum
AU - K. N. OLaughlin
PY - 2026
DA - 2026/10/20
PB - medRxiv
DO - 10.64898/2026.10.20.26365986
UR - https://www.medrxiv.org/content/10.64898/2026.10.20.26365986v1
AB - 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. MethodsWe 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. ResultsBetween 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). ConclusionFew 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.
ER -