Laboratory capacity in COVID-19 diagnosis and the need to enhance molecular testing in Ghana

Abstract

COVID-19 pandemic has posed an unprecedented threat to both public health and the global economy. In an effort to manage and contain this pandemic, the World Health Organization (WHO) has prioritised laboratory testing (https://www.who.int/dg/speeches/detail/who-director-generals-opening-remarks-at-the-media-briefing-on-covid-19-16-march-2020). We examine the testing capacity of the laboratory system in Ghana during the COVID-19 pandemic. According to WHO, gold standard for COVID-19 diagnosis is real-time reverse-transcriptase-polymerase chain reaction (RT-PCR). However, this molecular technique is not widely used in Ghana for disease diagnosis because of lack of infrastructure, lack of trained laboratory staff, high maintenance cost, and scarcity of reagents. Ghana has a three-tier health delivery system, with limited molecular diagnostic capacity. Three of the four public health laboratories (PHLs) have the capacity to perform molecular diagnosis of certain diseases. There are two main biomedical research institutions that are well-equipped to perform various molecular diagnostic tests. Nonetheless, their testing capacity is significantly limited in critical situations such as the current COVID-19 pandemic, which has led to testing backlogs and delays in returning test results at early stages of the pandemic. In an effort to address this situation, capacities of PHLs and nonclinical laboratories have been increased. Plans to use GeneXpert platform in certain areas of the country have been instituted in sixteen facilities, following system upgrades, risk assessments, and quality-checks. Enhanced molecular diagnostic testing in Ghana will help ensure a swift, accurate, and timely response to COVID-19 and future outbreaks. The data gained from these testing improvements may also help stimulate a robust bioeconomy because they can be used to improve the health of Ghanaians, as well as increase productivity through the implementation of data-driven and evidence-based policies. As outlined in WHO's Joint External Evaluation report for Ghana, the country faces several challenges, including the need to build strong laboratory systems and capacities that connect disease-specific areas.

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

“…The PCR testing footprint within the disease programmes like tuberculosis (TB), HIV, influenza and schistosomiasis were used by most of the low- and middle-income countries. 40 47–49 All they needed were supplies and the collaborations and donations helped with this. 11 47 50 With most of the low- and middle-income countries accounting for the highest burden of TB, 51 there have been progressive investments in diagnostics for TB and these have been leveraged for COVID-19 testing.…”

“…There were differences in the engagement of private stakeholders between high-income countries and the low- and middle-income countries and the point at which they were engaged. While the high-income countries private sector was engaged in the early days of the pandemic as test developers,23 32 37 in the low- and middle-income countries, they were engaged in testing 38–43. In most of the high-income countries, the private laboratories were engaged in testing quite late 23 29.…”

“…The existing systems worked in favour of low- and middle-income countries as they could tap into these to effect testing. The PCR testing footprint within the disease programmes like tuberculosis (TB), HIV, influenza and schistosomiasis were used by most of the low- and middle-income countries 40 47–49. All they needed were supplies and the collaborations and donations helped with this 11 47 50.…”

Comparable Detection of SARS-CoV-2 in Sputum and Oropharyngeal Swab Samples of Suspected COVID-19 Patients

“…KCCR, also located in Kumasi, Ghana, was established as a joint venture between the stakeholders of the Ministry of Health of the Republic of Ghana, KNUST, and the Bernhard Nocht Institute of Tropical Medicine (BNITM) in Germany. It is equipped with various laboratories and is currently the second-largest COVID-19 testing site in the country, with approximately 800 tests per day [15].…”

COVID-19: A unique opportunity to improve laboratory capacity for neglected tropical diseases in sub-Saharan Africa

“…Currently, all 36 states and the Federal Capital Territory of Nigeria have COVID-19 diagnostic capabilities, and 28 states across the 6 geopolitical regions have polymerase chain reaction (PCR) diagnostic capabilities. The COVID-19 diagnostic capacity of the Ghanaian health services increased from 2 to 16 centers within 7 months (8). However, as countries contemplate how to consolidate these gains in laboratory capacity for all endemic and emerging epidemic diseases, we are making a case for repurposing COVID-19 laboratories to support the control programs for neglected tropical diseases in endemic countries given the current status of the pandemic, with lockdowns being lifted and the need for established laboratories is decreasing.…”