Rapid establishment of public sector COVID-19 test and treatment programs across seven low- and middle-income countries: Implementation strategies and program monitoring results

The COVID-19 Treatment QuickStart Consortium[1] worked with governments in 7 low- and middle-income countries, Ghana, Laos, Malawi, Nigeria, Rwanda, Uganda, and Zambia, to implement COVID-19 test-and-treat programs at 776 health facilities, including training over 5,000 staff and facilitating a donation of 11,300 courses of the oral antiviral nirmatrelvir/ritonavir for treatment. This paper describes the process of implementing COVID-19 test-and-treat programs in each country, provides aggregate program monitoring data on numbers tested and treated from program initiation through June 2024, and analyzes program enablers and challenges. Between country-level program initiation (ranging from December 2022 for Zambia to September 2023 for Uganda) and June 2024, a total of 731,970 SARS-CoV-2 tests were conducted. Of 6,724 positive tests, a subset were documented to meet eligibility criteria for nirmatrelvir/ritonavir initiation, and 3,041 patients were prescribed nirmatrelvir/ritonavir. The largest number of prescriptions was in Zambia. Program enablers included decentralization of services, task-shifting from higher to lower health worker cadres, increased access to point of care antigen tests - including self-tests, and the integration of COVID-19 with other health services. Challenges included COVID-19 de-prioritization at the time of program rollout, test commodity stockouts and expiries, and dwindling national surveillance efforts. Learnings from rapid initiation and scale-up of COVID-19 test-and-treat programs in these 7 countries can be used to inform future pandemic preparedness strategies in LMICs.