Opinion: The lessons learned from COVID-19 test-and-treat programs

The COVID-19 pandemic exposed significant global inequities in access to therapeutics, vaccines, testing, and other medical interventions that help limit the impact of the disease. Inefficient supply and distribution, lack of quality services, and limited workforce capacity all exacerbated these disparities, underscoring the need for sustained investment in health systems around the world.

In September 2022, the COVID Treatment QuickStart Consortium was formed to accelerate access to COVID-19 oral antiviral treatments for high-risk patients in 10 low- and middle-income countries.

In addition to providing access to a supply of 100,000 treatment courses of oral antivirals donated by Pfizer, the consortium is working with generic manufacturers to accelerate the availability of high-quality, affordable medications in LMICs. The consortium also partners with national governments to support clinical guideline development, set up testing and delivery sites, train health care workers, and more.

Taking a test-and-treat approach

Current oral antiviral treatment options for COVID-19 are recommended for use within five days of symptom onset for high-risk individuals with mild to moderate symptoms, making it crucial to identify and connect eligible patients with treatment quickly. To help reach these patients, the consortium supports governments in embedding a patient-centered “test-and-treat” model that aligns testing, health care consultation, prescribing medication, and treatment delivery.

While this public-private partnership continues scaling up test-and-treat programs, lessons learned from countries, including Malawi, Nigeria, Rwanda, South Africa, Ghana, and Zambia, can shed light on some of the challenges — and opportunities — to implementing test-and-treat strategies and accelerating new product introduction for COVID-19 and beyond.

Empowering strong country leadership

Strong political and technical leadership at national and subnational levels allows for a robust COVID-19 response and has helped accelerate the introduction of oral antivirals.

Zambia, for example, is one of the first countries in Africa where patients had access to oral antivirals to treat COVID-19. Partnering with the consortium, Zambia rapidly imported donated treatment and tapped into its existing infrastructure to start test-and-treat activities just three months after the program was initiated.

The Zambian Ministry of Health accomplished this after recognizing the risk of a forthcoming surge during the holiday season and using a waiver to expedite treatment importation as soon as it became available. Additionally, Zambia promptly updated policy guidance and trained its health care workforce, supporting the swift introduction of treatment into various sites.

Given that introducing a new treatment also requires trust and community engagement, empowering local leadership, including provincial health directors, chiefs, and traditional healers has been vital to implementing COVID-19 test-and-treat programs.

Integrating test-and-treat into existing services

In settings with significant health care worker shortages, integrating test-and-treat programs into existing health infrastructure is essential for rapid product introduction. In Zambia, while preparing for product availability, the COVID-19 task force successfully integrated test-and-treat programs into existing entry points for high-risk patients, such as through established health clinics for HIV and tuberculosis. Other countries, such as Ghana, have been able to leverage foundational work from vaccination outreach as well as malaria testing to speed the rollout of a COVID-19 test-and-treat model.

Whether upgrading data collection systems to gather accurate information or training health care workers, countries are more successful when tapping their existing networks, rather than building new ones.

Building test-and-treat capabilities beyond COVID-19

Emerging public health crises are inevitable and have challenged and delayed the introduction of test-and-treat programs for COVID-19. In Malawi, for example, the Ministry of Health has been steadily building capacity to address COVID-19. However, a cholera outbreak in March 2023 required urgent attention. Through strong collaboration across Malawi’s cholera and COVID-19 response teams, the Ministry of Health was eventually able to synthesize available knowledge and develop strong plans to create government and training structures that supported the test-and-treat rollout for COVID-19.

Building test-and-treat models into interdisciplinary national emergency response programs as well as primary health care is imperative to improving patient outcomes, preparing for the next pandemic, and creating more resilient health systems.

Despite competing demands, to date, more than 12,000 treatment courses have been received in eight countries, over 700 sites have been activated, and 1,500 patients have been treated. Successes in Zambia, Ghana, Malawi, and elsewhere have shown that test-and-treat programs for COVID-19 are feasible, particularly with strong leadership.

Looking ahead

The COVID Treatment QuickStart Consortium supports partner governments in sustainability planning so that test-and-treat capabilities can address public health and health care delivery needs across multiple diseases, including malaria and tuberculosis. This requires addressing foundational issues related to regulatory authorization and timelines, procurement and supply chain management, workforce training, clinical treatment guidelines, and more.

As a unique cross-sector, public-private partnership, the consortium brings the multidisciplinary skills needed to address these complex challenges and ultimately illuminate a pathway forward for long-term scale-up and sustainability. No single group or donor can achieve this impact alone.

Learn more about the COVID Treatment Quick Start Consortium: https://covidquickstart.org/