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

The COVID-19 Treatment QuickStart Consortium worked with governments in seven low- and middle-income countries (LMICs), Ghana, Laos, Malawi, Nigeria, Rwanda, Uganda and Zambia, to implement COVID-19 test-and-treat programmes at 776 health facilities, including training over 5000 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 programmes in each country, provides aggregate programme monitoring data on numbers tested and treated and analyzes programme enablers and challenges. Between country-level programme initiation (Ghana, May 2023; Laos and Malawi, July 2023; Nigeria, June 2023; Rwanda, March 2023; Uganda, September 2023; Zambia, December 2022) and June 2024, a total of 731 970 SARS-CoV-2 tests were conducted. Of 6724 positive tests, a subset were documented to meet eligibility criteria for nirmatrelvir/ritonavir initiation, and 3041 patients were prescribed nirmatrelvir/ritonavir. The largest number of prescriptions was in Zambia. Programme enablers included decentralisation 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-prioritisation at the time of programme rollout, test commodity stockouts and expiries, and dwindling national surveillance efforts. Learnings from rapid initiation and scale-up of COVID-19 test-and-treat programmes in these seven countries can be used to inform future pandemic preparedness strategies in LMICs.