Marc Bosonkie 1*, Landry Egbende 1, Alice Namale 2, Olufunmilayo I. Fawole 3, Ibrahima Seck 4, Susan Kizito 2, Didine Kaba 5, Suzanne N. Kiwanuka 6, Issakha Diallo 4, Segun Bello 3, Steven N. Kabwama 7, Yves Kashiya 5, Fred Monje 2, M. D. Dairo 3, Berthold Bondo 8, Noel Namuhani 6, Mamadou M. M. Leye 4, A. S. Adebowale 3, Oumar Bassoum 4, Eniola A. Bamgboye 3, Manel Fall 4, Mobolaji Salawu 3, Rotimi Afolabi 3, Rawlance Ndejjo 2, Rhoda K. Wanyenze 2 and Mala Ali Mapatano 1
1 Department of Nutrition, Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa,
Kinshasa, Democratic Republic of Congo, 2 Department of Disease Control and Environmental Health,
School of Public Health, Makerere University, Kampala, Uganda, 3 Faculty of Public Health, College of
Medicine, University of Ibadan, Oyo, Nigeria, 4 Department of Biostatistics and Epidemiology, Kinshasa
School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of
Congo, 5 Department of Preventive Medicine and Public Health, Cheikh Anta Diop University, Dakar,
Senegal, 6 Department of Health Policy, Planning and Management, School of Public Health, College of
Health Sciences, Makerere University, Kampala, Uganda, 7 Barumbu General Hospital, Kinshasa,
Democratic Republic of Congo, 8 Department of Health Policy Planning and Management, School of
Public Health, Makerere University, Kampala, Uganda
Background: African countries leveraged testing capacities to enhance public health action in response to the COVID-19 pandemic. This paper describes
experiences and lessons learned during the improvement of testing capacity throughout the COVID-19 response in Senegal, Uganda, Nigeria, and the
Democratic Republic of the Congo (DRC). Methods: The four countries’ testing strategies were studied using a mixedmethods approach. Desk research on COVID-19 testing strategies was conducted and complemented by interviewing key informants. The findings were synthesized to demonstrate learning outcomes across the four countries.
Results: The four countries demonstrated severely limited testing capacities at the onset of the pandemic. These countries decentralized COVID-19 testing services by leveraging preexisting laboratory systems such as PCR and GeneXpert used for the diagnosis of tuberculosis (TB) to address this gap and the related inequities, engaging the private sector, establishing new laboratories, and using rapid diagnostic tests (RDTs) to expand testing capacity and reduce the turnaround
time (TAT). The use of digital platforms improved the TAT. Testing supplies were sourced through partners, although access to global markets was challenging.
Case detection remains suboptimal due to high costs, restrictive testing strategies, testing access challenges, and misinformation, which hinder the demand for
testing. The TAT for PCR remained a challenge, while RDT use was underreported, although Senegal manufactured RDTs locally. Key findings indicate that regionally coordinated procurement and manufacturing mechanisms are required, that testing modalities must be simplified for improved access, and that the risk-based testing strategy limits comprehensive understanding of the disease burden.
Conclusion: Although testing capacities improved significantly during the pandemic, case detection and access to testing remained suboptimal. The four countries could benefit from further simplification of testing modalities and cost reduction. Local manufacturing and pooled procurement mechanisms for diagnostics are needed for optimal pandemic preparedness and response.
KEYWORDS
COVID-19 testing capacity, experiences, lessons, COVID-19 response, Africa
TYPE Original Research
PUBLISHED 16 November 2023
DOI 10.3389/fpubh.2023.1202966