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Update on WHO COVID-19 testing guidance and experiences integrating antigen RDTs with testing strategies and deploying the tests

This is an overview of World Health Organization training provided in 2021, with links.

The training touches on the importance of testing and how to prioritize who must be tested within available resources. 

Guidance includes prioritizing symptomatic patients, those who are high-risk owing to COVID-19 exposure and people with frequent exposure to possible COVID-19 cases.

It also links discussions on lessons learned from the field in Ghana and the Democratic Republic of Congo. In the DRC, a successful rollout of rapid antigen testing, for example, saw more people tested, with rapid tests, within 24 hours than were tested within 3 days with PCR tests.

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Key considerations for SARS-CoV-2 antigen RDT implementation

WHO and FIND have collaborated on a new online training course, Key considerations for SARS-CoV-2 antigen RDT implementation. 

This course is based on the ‘SARS-CoV-2 Antigen Detecting Rapid Diagnostic Tests, An implementation guide’, released in December 2020, and is complementary to the policy guidance issued by WHO. It provides an overview of the major elements that must be considered before, during and after the implementation of antigen-detecting rapid diagnostic tests, or antigen-RDTs, for SARS-CoV-2 in order to support the implementation of RDT testing across the diagnostic network. This course is aimed at laboratory stakeholders, notably those involved in planning at central level but also other health stakeholders as well as all relevant professionals tasked with the implementation of RDT testing, including ministries of health, donors, public and private organizations.

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The SARS-CoV-2 Antigen RDT Training Package

It is aimed at trainers and health workers who will be using the tests in the field in both the theoretical and practical components of rapid antigen testing.

This training package can be used for face-to-face or remote training.

This training does not intend to address the implementation of Antigen RDT testing across the diagnostic network.

The material is free to download.

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New online course: Implementation of SARS-CoV-2 antigen-detection rapid tests

To support the response to COVID-19 and appropriate use of diagnostics in particular, WHO developed interim guidance and technical briefs to assist policy-makers and laboratories on testing for the virus that causes COVID-19, including using SARS-CoV-2 Ag-RDTs. In addition, WHO developed training packages such as the  training package on SARS-CoV-2 Ag-RDTs, released in November 2020, in collaboration with WHO collaborating center, FIND. In addition, an online self-learning course ‘SARS-CoV-2 antigen rapid diagnostic testing’ was published on the OpenWHO training platform in July 2021.

Building on these key milestone releases, WHO and FIND are now making available an online learning course to help countries to strengthen the roll-out of Ag-RDTs. The course is based on the SARS-CoV-2 Ag-RDT implementation guide developed by WHO in partnership with global health stakeholders through the Access to COVID-19 Tools (ACT) Accelerator. The course provides an overview of the major elements that must be considered before, during and after the implementation of Ag-RDTs for SARS-CoV-2 in order to support the implementation of RDT testing across the diagnostic network

The course has been launched in English on Monday 31st January 2022 and is freely available to all interested via the OpenWHO platform.  It is hoped that this course will facilitate the roll out of Ag-RDTs by national level implementors.

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WHO interim guidance: antigen-detection in the diagnosis of SARS-CoV-2 infection

This is an interim guidance published by the World Health Organization on how to select rapid antigen tests and when and where to use them.

Rapid antigen tests for SARS-CoV-2 are less expensive and faster. They should be used for primary case detection in symptomatic individuals and asymptomatic individuals who are at high risk of COVID-19, such as health workers. 

The tests should also be used for contact tracing, conducting outbreak investigations, and to monitor trends of disease incidence in communities. 

There are some variations in test performance, but these tests are very much suitable in track, trace, and isolate programmes aimed at interrupting community transmission.

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WHO interim guidance: Recommendations for national SARS-CoV-2 testing strategies and diagnostic capacities

In June 2021, the World Health Organization issued recommendations for SARS-CoV-2 national testing strategies.

At the time, the deadly Delta variant was the dominant variant globally.

WHO recommendations highlight the importance of diagnostic testing for SARS-CoV-2 as a critical component for both preventing the spread of the virus and controlling outbreaks. 

It advised that countries should have testing strategies in place that are context specific and that testing must be connected to other public health strategies like tracking, tracing, and treatment.

WHO’s list of who should be tested

  • Everyone with symptoms meeting the case definition for COVID-19, regardless of vaccination status or prior infection. 
  • Symptomatic individuals must be tested first and if there are not enough tests, those who are at high risk of severe disease must be tested first. 
  • Others for whom testing must be prioritized include health workers, hospitalized patients, and those who first showed symptoms in congregate settings.

Asymptomatic individuals should be tested if they were in close contact with  patients with a confirmed SARS-CoV-2 infection, health workers or long-term care workers.

What tests must be used?

PCR tests remain the gold standard. 

High-quality antigen tests can be used to scale up testing programmes fast.

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WHO interim guidance: Use of SARS-CoV-2 antigen-detection rapid diagnostic tests for COVID-19 self-testing 

In March 2022, the World Health Organization published its first guide to self-testing for COVID-19 using rapid antigen tests.

“The goal is to contribute to the effective management of COVID-19 as a public health problem,” their guidelines read.

The document emphasizes  that this option must be offered in addition to professionally administered testing.

WHO further explains that there is evidence showing users can use self-tests in a reliable and accurate manner, and that it is both acceptable and feasible to use the tests.

An explanation of when self-testing will be appropriate must be provided, as must complete instructions tailored for country specific contexts.

Clear messaging is also needed on what to do with the results of a test and what individual responsibilities will be.

Other recommendations include:

  • COVID-19 self-test kits should meet the existing World Health Organization (WHO) standards.
  • Self-tests should be accepted for screening and diagnostic purposes.
  • If positive, a self-test should, if appropriate in a country-specific context, be sufficient to link a positive-tested patient with clinical care and therapeutics. 
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SARS-CoV-2 antigen-detecting rapid diagnostic tests: An implementation guide

This guide, produced by FIND and the World Health Organization, provides information on implementing diagnostic programs using rapid antigen tests. 

It shows how rapid antigen testing can be implemented to support individual case management, contact tracing, surveillance and outbreak investigations.

The guide stresses the use of strict testing protocols and clear communication, and the need to protect healthcare workers against transmission. 

It outlines the different types of available testing  and where rapid antigen testing fits in. Rapid antigen tests are used to find a protein the body produces in response to an infection with the SARS-CoV-2 virus.

It produces fast results and is easy to use in low-resource settings where laboratories are unavailable. 

The guide provides step-by-step instructions on the use of these tests and how best to communicate and follow up on patients after a test result is obtained. 

It also explains the best practice of testing within 5 to 7 days of the onset of symptoms. 

While rapid tests are easy to use in most instances, the guide lists where they should not be used. 

This includes testing patients without symptoms unless they are a close contact of a confirmed case; where there are no appropriate infection control measures in place; where test results will not influence the treatment of the patients and for screening at points of entry.

The use of rapid antigen tests is also not advised  prior to elective surgery or blood donation.

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Technical guidance and courses on COVID-19 offered by WHO

WHO has published guidance and advice to help governments, health professionals and the general public respond to the COVID-19 pandemic. 

Ranging across multiple areas and numerous countries, the common thread through the technical guidance is the need for governments to make informed decisions and to clearly communicate with their citizens. 

OpenWHO, WHO’s interactive, web-based platform, also offers online courses to people preparing to work in epidemics, pandemics and health emergencies, or who already doing so. It has courses on COVID-19 in many of the world’s most commonly spoken languages.

WHO strengthens public health laboratory systems throughout the health emergencies preparedness, readiness response and recovery cycle.

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Global genomic surveillance strategy for pathogens with pandemic and epidemic potential, 2022–2032

Looking at the decade 2022-2032, WHO presents a global genomic surveillance strategy for pathogens with pandemic and epidemic potential.

The goal is to strengthen and scale surveillance of these pathogens to enable quality, timely and appropriate public health actions across local to global surveillance systems.

WHO’s strategy outlines five objectives with accompanying actions that need implementation plans.

It also highlights considerations to build global genomic surveillance over the next 10 years, as well as monitoring and evaluation mechanisms.

The report includes two annexes:

  • Strategy development and stakeholder engagement
  • Key WHO assets for the strategy.

Read report here