Sourcing COVID-19 testing supplies
It was estimated that as of December 2020, up to 80% of the testing reagents and supplies in the DRC had been donated by partners, including the WHO, US-CDC, USAID, UNICEF, the British Cooperation, China, Japan, Médecin Sans Frontière (MSF), the Global Fund, and the Government of Israel. The remaining 20% was acquired by the government through a World Bank-funded ‘Projet de Développement du Système de Santé’ project [8].
Initially, when the pandemic started, the partners had not yet produced any results. We had to resort to the existing stock of tests to perform the tests. As a public health laboratory, we had to resort to the stock of tests intended for the diagnosis of influenza that the School of Public Health of Kinshasa provides us with once a year. We had no choice. And when this stock ran out, while waiting for the partners to react, as it is not a matter of "tick to tock" with the partners, you have to place the order, it has to be evaluated, and so on... by the time it arrives, it takes all the time... During the first wave, we had to use this stock of flu tests. When it ran out, we had to resort to the stocks of the side laboratories. (KI1, Head of the respiratory virus laboratory in the Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, DRC)
What existed was that through the cooperation or partnership with WHO, which essentially supported the influenza surveillance laboratory, we received all the inputs to carry out the test, i.e. primers, transport media, culture media, etc. Today, we still receive the tests through this partnership. At the INRB level, as we also use the Covid voyage tests and thanks to our Indian partner, we do the supply by ourselves by purchasing the Covid voyage tests. (KI3, Responsible at the Programme National de Lutte contre la Tuberculose, Kinshasa)
Prior to the COVID-19 outbreak, Nigeria conducted a quantification exercise using projected numbers to estimate the need for testing supplies (including PPE). The Federal Government of Nigeria immediately released five billion naira (US$12.5 million) in special intervention funds and later an additional ten billion naira (US$25 million) to the Lagos state government, as Lagos was at the epicenter of the outbreak [9]. This funding included support for the procurement of testing supplies. Additional funding for testing supplies was made available through donor partnerships. Nigeria did manufacture RDTs locally, although several kits are in the developmental stage at the National Institute of Medical Researchers (NIMR), Lagos.
Sourcing the testing supplies, so for the RDTs we have some that are been sourced by procured at the National level and now distributed to State, we also have some that are being supplied by partners. ( KI-1, Assistant Director of NCDC, Abuja, Nigeria )
At the initial stage, testing supply are sourced from the national, although some are produced by the laboratories at different levels. Gradually the state produced some radiant while NCDC also produced some. At different levels the testing supplies has been sourced from state procurement and NCDC. ( KI-3, Deputy Director of Public Health of Oyo State, MoH, Nigeria )
In Senegal, at the onset of the COVID-19 outbreak, testing reagents and supplies were donated to the government from partners, especially the Clinton Health Access Initiative (CHAI), the Global Fund (GF), and the WHO. The procurement of the COVID-19 testing reagents and supplies was managed by the Government of Senegal through the Directorate of Pharmacy and Medicine (Drug Regulatory Authority). The procurement process followed the supply logistics scheme of the National Pharmacy Supply. Senegal began manufacturing antigen RDTs in July 2020 through the DiaTropix project, which was formally launched in November 2020 to support diagnostics , . The test kit was estimated to cost $1 and provide results in 10 minutes. The RDTs were piloted in four of 14 regions (July 2020 - January 2021), and countrywide roll out began in January 2021. The project donated up to 70,000 RDTs to the government. Production capacity was expected to reach 4 million units annually, with plans to export the kits regionally.
There are several levels, there are the reagents that are donated and that the government receives but also the laboratories are supplied within the framework especially with the travelers who had to do their tests and it was the responsibility of the lab. So the labs were buying tests outside of what the government was donating. ( KI1, Head of the Virology Department at the Istitut Pasteur, Dakar, Senegal )
At one point, there was a stock tension and the Ministry at the central level sent an email to ask for better rationalization of the tests because there was a shortage that was coming if we were not careful. It was the moment when we had an exponential increase of cases at the end of December and the central level had told us that they had ordered cartridges at the international level and that there was a stock shortage. So, they could not get their order while what was left here was running out. ( KI7, Deputy Chief Medical Officer of the Health Center, Senegal )
In Uganda, the government, through the Ministry of Health, procured testing supplies from other countries worldwide; for instance, PPE was obtained from China, while PCR amplification reagents were from obtained from Germany and the United States of America. The initial testing supplies were mainly sourced as donations or procured through funding from partners, such as the WHO, the UK, the Danish Government, the World Bank (approximately 90%), the private sector, and the government. Quantification of the required supplies conducted during preparedness evaluations for COVID-19 testing helped establish mechanisms to address gaps. Strategies to improve the procurement processes included pooled procurement through Global Fund support and the use of multiple suppliers, such as China, the USA, and Germany. Uganda has yet to manufacture testing supplies; however, the country is developing RDTs. An antibody RDT was launched on March 18, 2021, by Makerere University. The rapid antibody test kit was expected to cost approximately one dollar and provide results in 2–5 minutes. Development of this kit was supported by public and private sectors, including the Government of Uganda, Makerere University through the Research and Innovations Fund, the French Embassy in Uganda, the Uganda Bankers Association, and Astel Diagnostics Uganda, a WHO certified manufacturer. The kit underwent field validation before its released to the market in 2022.
Expansion of testing capacity
At the start of the epidemic in the DRC, only the National Reference Public Health laboratory (INRB) performed COVID-19 testing, with a capacity of 200 tests per day (March to June 2020). As of December 2020, the daily testing capacity had increased to approximately 2000 PCR tests per day. Testing services were decentralized in June 2020, and the number of testing laboratories increased to 25 in 14 of the 26 provinces, covering an estimated 60% of the population by December 2020.
The expansion of COVID-19 testing sites was guided by the availability of infrastructure (human resources and GeneXpert equipment), disease epidemiologists, with more laboratories in Kinshasa, the epicenter, and considerations of geographical equity. The GeneXpert equipment was previously used for TB diagnostics, and each of the 22 laboratories performed 20–30 tests a day. Antibody RDTs were integrated into the testing algorithm in June 2020 to further increase testing capacity. Additional capacity building was achieved through training at least 255 healthcare workers and the dissemination of SOPs. Training content focused on sample collection, storage, and diagnostics.
The number of tests performed increased monthly from March to December 2020 as the testing capacity improved. By the end of December 2020, a high-level PCR lab was set up at the University of Kinshasa to increase capacity further.
I myself have written a circular note to all my coordinating doctors to let GeneXpert be used concomitantly not only for Covid but also for HIV, monkeypox, Ebola, or any other pathology in a vision of strengthening the health system. This is how the PNLT has contributed to the extension of the diagnosis of Covid and this is an experience for which the DRC should be very proud and capitalize if there are best practices, this kind of best practices must be made known to people. We had also specified that for the best use, the same technician who does the TB test should do the Covid because he is the one who knows the machine and knows how to handle it, he will organize his time by saying to himself, for example, that in the morning he will do everything that is TB and in the afternoon, the Covid. (KI3, Director of the Programme National de Lutte contre la Tuberculose, Kinshasa, DRC)
We had to obtain the support of partners who provided us with inputs such as the CDC, the African Union who had really supported African countries with reagents and consumables. There are also the traditional partners of INRB such as WHO which is always with us, JICA, CHAI, MSF (which also helps us with consumables), UNICEF, the Global Fund which has also just been activated with the first order made since the first wave...as I told you earlier with the partners it is not from tick to tock...it is now that they are delivering everything that we ordered during the first wave. This is what allows us to improve our testing capacity. (KI1, Head of the respiratory virus laboratory in the Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, DRC)
In March 2020, Nigeria had 3 laboratories and could conduct 1500 tests daily. By October 2020, there were 69 testing laboratories with a total daily output of 15,000–20,000 tests (excluding private labs). The distribution of testing laboratories was guided by case load, population density, and equity, with priority given to the epicenters (Lagos, Abuja and Kano), including geopolitical zonal distribution. Of note, 45 of the 69 public labs use open PCR, while others use different platforms, including GeneXpert, Abbott, and Cobas.
Ok, so the testing capacity, as the cases kept increasing, there was a need to actually get the true picture of the prevalence or the numbers of cases in the country; so there was a need to increase the testing capacity across the state; so that led to the establishment of labs in the state which led to the improvement of the number of samples being collected. Another, thing that was done was to establish sample collection sites. Before then, sample collections were a kind of being centralized; people will had to travell down to some places to have their samples collected. But after a while it was decentralized in such a way that there was establishment of sample collecting sites at least one per Local Government Area, so this enabled people at the lower level to have their samples collected promptly. (KI-1, Assistant Director of NCDC, Abuja, Nigeria)
At the early stage of the pandemic, samples were taken from different centers to Abuja for test, but over time laboratories were decentralized. For example, Oyo State has one laboratory, but as the pandemic moved on, the State is working on having the second laboratory to ensure fast release of COVID-19 results. (KI-3, Deputy Director of Public Health of Oyo State, MoH, Nigeria)
In Senegal, the testing capacity improved rapidly between March 2020 and July 2020 as the number of laboratories capable of testing for COVID-19 and the number of tests that could be performed by the laboratories increased. The number of testing laboratoriess increased from 1 (Pasteur Institute) in March 2020 to 18, with PCR testing capacity totalling 5000 per day in all 14 regions across the country by December 2020. GeneXpert equipment was set up in certain regions to increase capacity. The distribution of the testing laboratories was guided by the existing health system structure, which ensured the equitable distribution of services. Senegal is also manufacturing antigen RDTs locally.
The decentralized laboratories were supported by the government. At the beginning of the pandemic, only two laboratories were authorized by the State to conduct testing, and both were in the capital. Later, the government extended diagnostic testing to the regional level. It was necessary to wait for a secure technical platform before launching the diagnostic capacity in other areas.
The tests and inputs needed to use the devices were purchased by the government and routed to the decentralized laboratories. The laboratories were equipped with specific consumable equipment for COVID-19 (recalibrated to support COVID-19 diagnostics). The staff in some laboratories received support from, for example, Pasteur Institute staff who were deployed at the beginning of the pandemic (Darou Tanzil case in Touba) to help set up the laboratories and familiarize the personnel with the equipment. These staff members contributed to building the capabilities of laboratory workers, including the use of Genexpert.
In fact, we all used PCR. We in the lab we have the GeneXpert and also the ministry often used them for the tests of tuberculosis. Now that, the Ministry of Health had received GeneXpert cartridges, the strategy was to distribute them to decentralized laboratories so that they be available at the level of the laboratories on the time of transmission and they could also be used for the urgent cases (KI-1, Head of the Virology Department at the Institut Pasteur, Dakar, Senegal)
I think that the government has given support, at least in relation to the tests, especially support in reagents (KI-1, Head of the Virology Department at the Institut Pasteur, Dakar, Senegal)
The COVID-19 outbreak was projected to be widespread in Uganda; thus, the National COVID-19 Task Force recommended different testing strategies and thresholds for adjustments, including the following: i) if testing reached 500 samples daily at the Uganda Virus Research Institute (UVRI) laboratory, the country would activate mobile laboratories; ii) if samples increased to 1000 per day, other labs would be activated, e.g., the Joint Clinical Research Center; iii) at 3000 plus tests per day, the third level with higher output would be activated, including PCR equipment at the Central Public Health Laboratories (CPHL), known as Cobas 8800 (normally used for viral load monitoring for HIV); iv) at > 5000 tests per day, private sector labs would be activated. This strategy was not strictly followed. Thus, the mobile labs were activated later than planned because they required imported point-of-care equipment. Additionally, there were procurement challenges as a result of increased global demand. The private sector laboratories were activated earlier than planned, likely because they had preexisting capacity. Testing capacity was expanded from 2500 tests per day to over 8800 tests per day as the number of laboratories increased from one in March 2020 to 16 in December 2020. The distribution of testing sites was guided by the existence of infrastructure and the disease epidemiology (prioritizing high-risk POE and high-burden districts). By March 2021, the number of labs had increased to 21 as a result of continued certification.
Strategies implemented to generate testing capacity included leveraging existing laboratory capacity for endemic disease systems to support centralized PCR testing. The two major laboratories providing 90% of the PCR testing services, UVRI and CPHL, were already supporting disease surveillance; UVRI provided HIV care services, and CPHL performed centralized viral load (VL) and Early Infant Diagnosis (EID) testing. This multiple disease pathogen testing or ‘multiplexing’ strategy contributed substantially to the rapid ramp-up of testing.
Improving access to testing
In the DRC, access to testing improved largely due to decentralization, although there were still major gaps in geographical coverage. Of note, 14 of the 26 provinces did not have a testing site as of December 2020, and samples were shipped by air to laboratories in the capital, Kinshasa, with the support of the WHO and CDC. Testing was provided free of charge to everyone except travelers. The introduction of POC RDTs improved access to testing. The introduction of payment for testing travelers was considered a major barrier, and there were reports that this approach may have reduced testing access. The ‘mass testing’ implemented in Kinshasa (June 2020) increased access to testing. Testing access remained limited in the DRC, as only 6% of health facilities provided testing, and many provinces did not have a PCR testing site.
We have improved access to tests by decentralizing and extending the range of tests. Before, tests were only available at the INRB, then only at the provincial level, either the provincial laboratory or the laboratory that had the GeneXpert. Today with the antigenic tests, we have the HGR and the CS of reference which have tests and tomorrow we want the Covid tests to be like the RDT of malaria, that they are even available to the community because the ideal is to test everyone. (KI-3, Responsible at the Programme National de Lutte contre la Tuberculose, Kinshasa, DRC)
At the beginning, there was a big delay in the delivery of results, but then there was an improvement because the private sector took over; in terms of change, it was significant during the response; the introduction of Genexpert equipment lightened the load and allowed some provinces to do the tests on site.
Per capita testing has not improved at the state level, but the private sector has taken over. The country does not have the capacity to produce test kits locally (KI-8, Director of the Health Laboratories Division, Kinshasa, DRC)
In Nigeria, in May 2020, the existing (23) national GeneXpert equipment previously used for TB diagnostics was recalibrated to make it available for COVID-19 testing. The addition of GeneXpert testing allowed for a major increase in testing numbers and improved the TAT. However, the lack of skilled human resources persisted even with this strategy. In addition, TB diagnostics at one center decreased by 30%.
In September 2020, antigen RDTs were incorporated into the testing algorithm. Two RDTs (Abbot and Biosensor) were approved for use in special settings and are currently being piloted in the National Youth Service Corp (NYSC) camps. RDTs have not been recommended for replacing PCR testing due to sensitivity and specificity limitations. The current recommendations for the use of the Ag RDT test are in the following contexts in Nigeria:
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Health care settings: Testing of health workers for COVID-19 and patients with symptoms of COVID-19 presenting in hospital triage areas. A positive RDT test confirms SARS Cov-2 infection
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Contacts of PCR confirmed cases: A contact who tests positive on using AgRDT is considered confirmed positive for COVID-19. If the AgRDT is negative, the person is considered negative.
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Closed settings: Boarding houses, prison inmates, NYSCs, and other similar closed settings.
The first case in each setting that is positive on an AgRDT should be retested by PCR for confirmation. Once a positive test has been confirmed by PCR, all subsequent AgRDT-positive results are considered confirmed and retesting is not required.
Access to testing improved over time in Nigeria due to an increase in the number of sample collection and testing sites. Other strategies included the provision of free testing at public locations (except for travelers) and regular communication to the public regarding where they could access testing. All COVID-19 testing was provided free except at the fee-paying labs shown in the map. One key issue observed was an inadequate demand for testing services, with underutilization of the established testing capacity. In response, the Nigeria Centre for Disease Control (NCDC) conducted a campaign to test for COVID-19 when people experienced influenza-like symptoms. Other key barriers to access the long distances people were required to travel to the few sample collection and testing sites, the long TAT for results, stigma and misconceptions in the community, and poor dissemination of information regarding testing center locations.
These barriers were addressed by providing health education to the communities on the need to address stigma as part of the risk communication. The testing cost for travelers was also thought to be a limitation. Excessive demand for testing was noted among people in high positions who did not meet the testing criteria but demanded testing alongside their family members and staff. Nigeria has increased the number of COVID-19 testing laboratories from 3 to 97 (as of Jan 2021) since the beginning of the pandemic in 2020. These laboratories are spread across the 36 states and FCTs, with 79 laboratories open to the public at no cost to ensure that Nigerians can access testing when needed. However, international travelers who require a negative PCR test result before traveling must pay for testing at an accredited private laboratory of their choice. The public laboratories are intended for in-country response efforts and are not to be used by passengers coming in or out of the country. Overall, the laboratories (public and private) have the capacity to test at least 15,000–20,000 samples daily (January 2021).
So, for the testing strategy there were some public health laboratories across in some states even before COVID-19. We have this network of laboratories but with COVID-19 and the cases being reported in all the states and with the needs for us to have prompt diagnoses made, which will inform your next action, so there was a need to actually established more labs in more states, so these laboratories were established in many states. So, we have a number of states which never had laboratories before, which were sending their samples to other states before which at sometimes led to some delay in the testing but with the establishment of labs in these other states it improved the turnaround time for the samples and we also got support from partners, especially some machines that were being used for TBs and all that which are also used for this testing, so these are some of the testing strategies that were modified as the response activities went on(KII-15 34-years old case Investigator and Surveillance Pillar Member, at National EOC, from NCDC Abuja).
I want to understand the question perfectly, are you talking about lapses in terms of the turnaround time for the result to come out or lapses in terms of the number of samples been tested or the two? If you are talking about lapses in terms of the turnaround time it's actually about, what actually affected the turnaround time in the lab is dearth or insufficient reagent, that is the only, at least in the lab where I was seconded to, I would say that was the main thing that is obvious to me, not the personnel, not the facilities, there were ready 24hrs, but the reagent, once they ran out of reagent before they sent it from Abuja to that side it takes a long time, so at times they now have batches they will now be releasing result in batches after some time but once they have it result would be coming out in good time so those were the major challenges. (Interviewer: testing strategy?). Yes was not enough so that lasted for at least, till I left, I was just there as data clerk for some time, till I left anyway that problem persisted so may be now it's been taken away I wouldn't know. So the other one is too like they realise that coming to a center position will be faster than the time it would take for someone to commute from point A to point B wanting to get samples, you will save time if those people themselves come to a convergent place and then you are there to just take all the sample and then immediately go to the lab, so the number you would do would be better that's why I actually applauded creating collection site, just to increase the number of samples been tested. (KI-10, National Laboratory of Oyo State, Nigeria)
In Senegal, access to testing improved largely as a result of the decentralization of testing services and deployment of POC tests and RDTs. In addition, testing is provided free of charge, except for outgoing travelers, who pay the equivalent of US$70.
The fact, people can be tested in all health centers. The fact that Senegal already had a well-oiled surveillance system. The fact that they have set up mobile laboratories even in other regions. The fact that the tests in Thiès are done by the IRSF, we have decentralized the tests to the other regions. ( KI3, ETC Coordinator of Dialal Diam Hospital, Senegal )
There are two things, for the patients there is no problem. The doctor who suspects that a person has COVID, asks for the test and in general there is no problem for this patient to have the test. Now the problem is with the travelers who had to take the test because they had to pay, go to the laboratory and wait in line to be tested. But for the patients who were in the suspect group, they got their test in time and it's free. ( KI-18, Immunization Management Officer, WHO, Senegal )
Uganda improved access to testing through the decentralization of services and an increase in the number of sample collection and testing sites. The sample collection and testing sites were widely publicized in the media and through Ministry of Health (MOH) communications. Testing was provided free of charge to everyone except for travelers. The notification system in the community and measures introduced to pick up samples from those suspected to be infected improved access to testing. Prior to the COVID-19 pandemic, Uganda had a preexisting strong national health laboratory system with comprehensive infrastructure at the central and subnational levels. Many laboratories had the capacity to perform PCR testing. In addition, there was an established sample transport network linking 97% of national health facilities to testing labs.
Improving TATThe turnaround time was reduced from 2–3 weeks in the early phase of the epidemic (March 2020) to 24–48 hours for provinces with a testing site (July 2020) in the DRC. This reduction was largely due to the decentralization of testing services, i.e., the long TAT for results led the MOH to change strategy and decentralize testing services. However, provinces without a testing site still have their samples routed to a laboratory through Kinshasa by air, with a median TAT of 7 days. The long TAT was a major challenge to surveillance, as there were delays in decision-making, including the isolation of individuals with confirmed cases and contact tracing. The laboratory results were returned electronically through phone calls, SMS texts or emails before a hard copy was shared with the health professional or the individual tested, e.g., a traveler.
In Nigeria, the TAT from sample collection to result return was 24–48 hours for PCR testing and under 24 hours for GeneXpert testing as of November 2020. This is a significant improvement from 5 days in the early phase of the outbreak. Improvement has been realized as a result of increased laboratory testing capacities, the decentralization of services, adoption of POC testing and RDTs, and improvements in the sample transportation system. Dedicated sample collection teams were coordinated and trained to support sample transport. The key challenges noted were the poor road network, logistical complications, and weak coordination capabilities across the diagnostic testing laboratories. For example, there were reports of sample delivery to laboratories that were not properly labeled and could not be directly linked to a particular source, and such samples were destroyed. This challenge was precipitated by the inadequate supply of testing kits and PPE, poor synchronization between surveillance and laboratory data and long TATs. The results from public and private laboratories are returned to the NCDC and state government EOC, from which they are communicated to the tested individuals and health providers. The results return leverages a preexisting system within a database at the office of the Disease Surveillance and Notification Officer at the local government level, which routinely collects and collates facility-level data into the District Health Information System (DHIS2) for real-time transmission and collation at the state and federal levels. Following the COVID-19 outbreak, the testing labs were linked to the states’ DHIS2 IT infrastructure to enhance the data transmission speed.
Although the TAT has improved, further improvement is required, as evidenced by the comments of the key informants below:
TAT is still a challenge. Tests that should be within 2/3 days are delayed till 2 weeks and by the time you have test results coming after 2 weeks, the person is no longer infectious even if the person was positive(KII-4, Surveillance Pillar Member, State EOC, SS)
The turnaround time of result makes it difficult at times. In some cases, the incubation period would have elapsed before the result is out. It affects surveillance because the confirmed cases that have exceeded the incubation period are not ready to cooperate with us most of the time(KII-12, Laboratory Team Member, State EOC, SW)
In Senegal, the TAT from specimen collection to results return improved from 2–3 days to 9 hours over three months (March, April and May 2020). Strategies that contributed to the improved TAT included the decentralization of testing services, the use of POC testing (including RDTs), and the expedition of results return. The results were communicated through phone calls and in writing via the internet, for example, email notifications.
In Uganda, the TAT improved by 12–72 hours on average between March and October 2020. The TAT averaged 2 to 7 days in March 2020 and decreased to 8 to 24 hours in October 2020, although the range varied widely depending on the laboratory and geographical location. Districts furthest from the central labs reported TATs as long as 2 weeks. The TAT was the shortest in areas with POC testing. However, given that most of the testing was centralized, efforts were made to improve efficiencies in the transport network, including a notification system that alerts the central laboratory and the district that a sample has been collected. Other strategies to improve the TAT included the use of a sample tracker system, an increase in the number of vehicles for sample transport, the automation of laboratory systems where possible, and the use of electronic systems for results transmission from the laboratory to the EOC, district and facility. The adoption of RDTs began in December 2020 to further reduce the average TAT.
Additional work shifts were introduced and volunteer staff were deployed to further increase testing capacity in these laboratories and reduce the TAT. Some laboratory capacity/equipment was reserved for VL, EID, surveillance and other disease support at both CPHL and UVRI to minimize the risk of the displacement of the diagnosis of other diseases. A further increase in capacity was realized through ii) partnerships with the private sector (including academia, private for-profits, and private non-profits). This strategy increased testing access and reduced the burden of testing on the government. This strategy also provided a suitable option for individuals who wished to test but were not eligible for free testing, such as travelers. iii) New mobile laboratories were established at three (3) border POEs to test truckers along trade routes since the majority of the early COVID-19 confirmed cases were imported through these POEs. These mobile laboratories utilized GeneXpert equipment and improved efficiency and the TAT at the borders from 2–7 days to 12 hours. The establishment of mobile laboratories at the border strengthened disease surveillance. iv) Pooling of samples was implemented at a few laboratories, including CPHL and Makerere University.
The capacity has improved so much. So the testing capacity has gone very high especially with the introduction of RDTs. Then, increase in the number of laboratories especially private laboratories and academia from universities has also increased this. The introduction of other testing platforms like RDTs and gene extract have also increased so the testing capacity has gone very high although the reporting is known to be poor. So that is the general comment I can give about the testing capacities for COVID 19 across the country. But it needs an enhanced quality check on the old system. There are a number of quality issues as the capacities are being expanded so rapidly there these issues across the country. There is a need for enhanced supervision and that type of thing by CPHL or the department of the laboratories. (KI2, Responsible at the CPHL, MoH, Uganda)
Furthermore, a laboratory information management system with an electronic results transmission and download system was also introduced. This system helped to improve the TAT. The established laboratory network was leveraged to improve COVID-19 testing access. However, one of the challenges encountered was that people still wanted to be tested at UVRI. To mitigate this, UVRI reassured the public about the quality of the testing offered by the accredited laboratories.
In Uganda
For PCR, we have over 25 labs; they must be close to 30 by now because yesterday I got to know that there are two under the pipeline for activation and some of these labs are private for profit. That has been the game changer and it is something that I thought I should mention as a new improvement after the pandemic for the last three months. First of all, the ministry guided on the testing; I’m sure the first pricing which was at 60USD that they mentioned some time back has been dropping and many labs are testing below 60USD. It is still high but there is even more hope for prices dropping and so a large number of populations are able to access timely results when they need it. In total maybe I can say the capacity we usually have for public labs comes from CPHL where they can produce about 4,000 tests per day and UVRI which can produce about 2,000 tests per day though their average is 1,000 or 500 tests per day. The rest of the other labs are becoming commercial; they are reserving it for commercial purposes. I should mention Makerere which is using a cost recovery means and their tests are way cheaper than compared to any other lab. You can have a test at maybe Shs. 180,000 and about 30USD; something of that sort. Makerere can do quite a lot like about 4,000 tests per day; like I said, I can get you that capacity that is well calculated and we have it on paper. (KI1, Responsible at the CDC, Uganda)