A systematic review of strategies adopted to scale up COVID-19 testing in low-, middle- and high-income countries

Abstract

ObjectiveWe undertook a systematic review of strategies adopted to scale up COVID-19 testing in countries across income levels to identify successful approaches and facilitate learning.MethodsScholarly articles in English from PubMed, Google scholar and Google search engine describing strategies used to increase COVID-19 testing in countries were reviewed. Deductive analysis to allocate relevant text from the reviewed publications/reports to the a priori themes was done.Main resultsThe review covered 32 countries, including 11 high-income, 2 upper-middle-income, 13 lower-middle-income and 6 low-income countries. Most low- and middle-income countries (LMICs) increased the number of laboratories available for testing and deployed sample collection and shipment to the available laboratories. The high-income countries (HICs) that is, South Korea, Germany, Singapore and USA developed molecular diagnostics with accompanying regulatory and legislative framework adjustments to ensure the rapid development and use of the tests. HICs like South Korea leveraged existing manufacturing systems to develop tests, while the LMICs leveraged existing national disease control programmes (HIV, tuberculosis, malaria) to increase testing. Continent-wide, African Centres for Disease Control and Prevention-led collaborations increased testing across most African countries through building capacity by providing testing kits and training.ConclusionStrategies taken appear to reflect the existing systems or economies of scale that a particular country could leverage. LMICs, for example, drew on the infectious disease control programmes already in place to harness expertise and laboratory capacity for COVID-19 testing. There however might have been strategies adopted by other countries but were never published and thus did not appear anywhere in the searched databases.

Rapid response of a public health reference laboratory to the COVID-19 pandemic

“…The recruitment of extra human resources and training were two strategies adopted mainly by upper-middle-income countries and lower-middle-/low-income countries, respectively, to increase COVID-19 testing capacity [39], and these strategies were also adopted by IAL. The qualified IAL professionals who volunteered at IAL-2 were instrumental in training the staff hired during the pandemic.…”

Scaling-up Evidence-based Interventions for Communities of Color With Marked Health Disparities

“…29,30 Nonetheless, interventions should be designed and implemented with the recipients (eg, communities of color) at the center if the goal is to reduce morbidity/mortality. COVID-19 has taught many researchers/clinicians/policymaker that 31 identifying the essential elements of the intervention is critical because that component can be adapted to different context and scaled. 12 Lessons learned from COVID-19, include a focus on the importance of the essential intervention components and how adaptable those components are to various settings.…”

“…Moreover, an essential part of the discussion has also included scalability of interventions and equity. Pre-COVID, the thought among implementation research about scalability of interventions was confined to global health, but the post-COVID world is now focusing on scalability of interventions among individuals of various economic strata in the United States 31…”

Wastewater-based surveillance models for COVID-19: A focused review on spatio-temporal models

“…The global capacity for real-time disease surveillance varies among countries, as has been partially demonstrated by analysis of self-reported data on detection, control and prevention of outbreaks across 182 countries [ 9 ]. Detection and surveillance in most Low and Middle Income Countries (LMIC) has relied on existing testing capacities [ 10 , 11 ]. In the UK, the two largest national randomised studies of COVID-19 prevalence were run by Imperial College London and the Office for National Statistics (ONS).…”