It is high time that Africa starts evaluating the potential of Point of Care (POC) testing and considers methods via which to embed POC into our health systems. POC technologies offer the opportunity for increased diagnostic capacity in resource limited settings, where there is lack of electricity, technical capacity, reagents, and infrastructure.
COVID-19 has spread rapidly around the world, affecting every community directly or indirectly. Stringent measures have been put in place by all countries to slow the spread of the disease, including surveillance measures to enable rapid detection, isolation, testing, and management of suspected cases. Surveillance is also necessary to monitor the longer-term trends of COVID-19 transmission and the changes in the virus.
Testing is an integral part of COVID-19 disease surveillance. It is impossible to control the pandemic without proper testing and contact tracing. However, out of the 1.3 billion people in Africa, only 63 million people have been tested for the disease – highlighting a huge testing gap on the continent. Additionally, only 7.3 million cases of COVID-19 have been reported so far and it is believed that many more people might have been exposed to the virus than has been reported. The reported tests are based on the ability and capability of countries in Africa to test hence many cases go undetected and are not reported.
There are two diagnostic testing systems on the continent: A centralised and decentralised system.
– In a centralised setting, samples are collected and then delivered to lab for testing, and this usually done by lab professionals.
– For decentralised or POC testing, tests are done where the patient’s care is delivered and are mostly done by non-lab professionals (e.g. nurses)
– In a centralised setting, samples are collected and then delivered to lab for testing, and this usually done by lab professionals.
– For decentralised or POC testing, tests are done where the patient’s care is delivered and are mostly done by non-lab professionals (e.g. nurses)
COVID-19 has spread rapidly around the world, affecting every community directly or indirectly. Stringent measures have been put in place by all countries to slow the spread of the disease, including surveillance measures to enable rapid detection, isolation, testing, and management of suspected cases. Surveillance is also necessary to monitor the longer-term trends of COVID-19 transmission and the changes in the virus.
PCR tests are considered the gold standard
Currently, Polymerase Chain Reaction (PCR) testing is the most common method of COVID-19 testing, which has been largely adopted and validated by many states in Africa because of its high sensitivity and performance. The PCR test is normally done in a centralised laboratory setting. While highly sensitive and accurate, PCR testing requires a lot of resources, from the procurement of the instruments, to seting up testing infrastructure and training adequate numbers of laboratory personnel. Therefore, building capacity and developing the right infrastructure systems to accommodate PCR testing is a major challenge to most countries on the continent. This, results in low testing capacities and limited data to trace the movement of the COVID-19 disease.
POC testing could be a game changer
To spread the reach of Covid-19 testing in Africa, the continent needs to be innovative and allow for new, quality, affordable and rapid testing methods to be increasingly implemented on the continent. In this regard, POC or decentralised testing is the direction Africa needs to take. POC allows for more tests to be taken by to a larger part of the population, the whole system is relatively cheaper and rapid results are generated – allowing more infections to be diagnosed and reported, ultimately allowing for the extraction of more COVID-19 data which can ultimately be used in response to the pandemic.
The below advantages can be linked to POC or decentralised testing of the COVID-19 virus:
– POC tests can be undertaken in various designated places like airports, border entry points, schools, churches, and many other places, allowing for tests to be carried out in remote area and at the community level where they are largely needed.
– The cost of testing in Africa is still high. Currently, the cost per PCR test for COVID-19 in Africa ranges between USD 30 and USD 80. This makes it unaffordable and inaccessible to a large percentage of the population. The high cost of testing is attributed to over reliance on centralised testing approaches which have many overheads (attributed to test inputs and materials and human resources). POC testing offers cost savings with regards to lower staffing costs and device costs.
– By adopting a decentralised testing approach for COVID-19, more laboratory resources can be freed up to pick up for the diagnosis of other prevalent diseases on the continent (for example TB).
– POC tools have been developed which perform at the equal level as a PCR test. There are existing POC tests in the market which have comparable sensitivity and accuracy and do not need further confirmation, e.g. LumiraDx SARs-CoV-2 Ag.
– The cost of testing in Africa is still high. Currently, the cost per PCR test for COVID-19 in Africa ranges between USD 30 and USD 80. This makes it unaffordable and inaccessible to a large percentage of the population. The high cost of testing is attributed to over reliance on centralised testing approaches which have many overheads (attributed to test inputs and materials and human resources). POC testing offers cost savings with regards to lower staffing costs and device costs.
– By adopting a decentralised testing approach for COVID-19, more laboratory resources can be freed up to pick up for the diagnosis of other prevalent diseases on the continent (for example TB).
– POC tools have been developed which perform at the equal level as a PCR test. There are existing POC tests in the market which have comparable sensitivity and accuracy and do not need further confirmation, e.g. LumiraDx SARs-CoV-2 Ag.
The benefits of large-scale COVID-19 testing have been demonstrated in several countries. However, most low-middle income countries (LMICs), including the majority of African countries, lack capacity for large scale testing. As the pandemic evolves, it is increasingly important to utilise POC tests that will facilitate proper last mile epidemiology, inform treatment and public health interventions. POCs will make it possible to test a larger part of the population, detect more COVID-19 cases, and tracking the movement of the disease easily and quickly, hence increase the ability to the control of the pandemic in Africa. As new technologies emerge, what is most cost-effective, most affordable, and most accurate will continue to change. Funding, regulation and implementation must therefore remain flexible to these changing circumstances.
In April and August 2021, AHB in partnership with LumiraDx, hosted two discussions on COVID-19 testing in Africa. Key stakeholders represented at the discussions included the Africa CDC, African Society for Laboratory Medicine, Kenya Medical Research Institute (KEMRI), Pathcare Kenya, Meditest Diagnostics Service, Stellenbosch University and Addis Ababa University. The session aimed to set a firm ground on how we can make the diagnostics quicker, better and more cost effective for both NCDs and CDs in Africa, during and beyond the COVID-19 pandemic.
To read our session reports please click on the links below:
