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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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Next Generation Pathogen Genome Sequencing Trainings in Bangladesh

Bangladeshi scientists participate in next generation genome sequencing of SARS-CoV-2 genome

In November 2022, The Child Health Research Foundation (CHRF) of Bangladesh announced that, for the first time, the SARS-CoV-2 genome was sequenced at the Next generation sequencing Research and Innovation Lab, Chittagong (NRICh). CHRF stated, “With support from our friends at FIND, CHRF helped set up the lab and provided training for its members. We will continue decentralising genomics and building scientists for Bangladesh.”

Read more about this achievement here

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The Global Fund’s COVID-19 Response Mechanism (C19RM)

First established in April 2020, the Global Fund’s COVID-19 Response Mechanism (C19RM) was designed to rapidly respond to the global health emergency created by SARS-CoV-2. Building on 20 years of experience in fighting three of the deadliest infectious diseases, and using its comparative advantages in procurement, deployment at scale and existing relationships with implementing countries and communities, the Global Fund was swiftly able to step up its COVID-19 response.

Since first establishing C19RM, the Global Fund has been able to expand, refine and develop the mechanism. It learned lessons and responded as the pandemic evolved and adapted to changing country needs and the availability of new tools such as self-testing and oral antivirals.

Through C19RM, the Global Fund has been the primary source of funding for all COVID-19 tools, except vaccines. Thanks to the generous backing of donors, the Global Fund has awarded over US$4.9 billion since March 2020 to 109 low- and middle-income countries (LMICs) and 22 multi-country programs, to support health and community health workers and communities fight and recover from COVID-19.  

The Global Fund has been able to support LMICs in responding to the new virus, mitigating the knock-on impact on HIV, TB and malaria programs and protecting the health services. C19RM support included providing access to diagnostics, oxygen, therapeutics, and personal protective equipment (PPE) at a time of unprecedented global demand, as well as adapting lifesaving HIV, TB and malaria services and investing to reinforce overstretched health systems, including supporting community health workers.

In addition to provision of COVID-19 tools, countries were encouraged to invest in crucial Community interventions, such as responding to human rights and gender related barriers to services, community-led monitoring, community-led advocacy and research, social mobilization, building community linkages and coordination, institutional capacity building, planning and leadership development, and gender-based violence (GBV) prevention. Working through the community engagement strategic initiative partners, communities and civil society were able to access technical support to engage in the process.  

C19RM on Diagnostics

From the start of the pandemic, the Global Fund took a leading role in supporting LMICs to scale up testing for the new virus, based on 20 years of experience in procuring diagnostics and investing in laboratory capacities.

C19RM investments have backed countries’ efforts to address the acute difficulties in sourcing PCR and rapid antigen diagnostic tests (Ag-RDT) and scaling-up testing in response to COVID-19 – including supply-side constraints, high costs, quality issues, long delivery times and delays in the issuance of guidance on testing strategies. C19RM procured PCR tests and Ag-RDTs, strengthened laboratory systems and network capacities, and reinforced national testing strategies and governance. In the first phase of the pandemic, the Global Fund worked closely with ACT-Accelerator partners to ensure equitable allocation of the extremely limited volume of PCR diagnostics then available to LMICs, while working to secure greater production capacity, negotiate pricing and tackle implementation bottlenecks. Following the introduction of WHO-approved Ag-RDTs in September 2020, the Global Fund encouraged their deployment and the introduction of community-based testing and self-testing.

Alongside large-scale procurement and deployment of diagnostics, the Global Fund has also been supporting technical capacity building through Project STELLAR, supporting a group of 23 African countries in scaling-up COVID-19 testing, including wastewater testing, improving diagnostic governance and data management, and galvanizing longer term strengthening of laboratory systems, a key component of resilient and sustainable health systems.

In 2023, as the acute phase of the disease had passed and COVID-19 is becoming endemic in many countries, the priorities of implementing countries have shifted towards longer-term investments in health infrastructure and capacities for pandemic preparedness. To respond to counties’ needs, C19RM priorities have shifted to strengthening key components of an effective health system, especially laboratory systems, surveillance, human resources (including community health workers), supply chain management, oxygen and respiratory care, infection prevention and control (IPC), pandemic preparedness and response (PPR) and sustainable waste management. In addition, the Global Fund continues to work towards limiting the impact of COVID-19 on high-risk populations in LMICs through Test and Treat integrated service delivery models. Key activities include facilitating access to novel treatments and providing technical assistance to integrate treatment into existing public health infrastructure.

To learn more, visit the Global Fund’s C19RM page

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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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COVID-19 Ag RDT training package for community healthcare workers

The SARS-CoV-2 antigen rapid diagnostic test community health worker (SARS-CoV-2 Ag RDT CHW) training package is a structured, comprehensive collection of training resources and tools.

It aims to support institutions to organize, run and evaluate training of trainers and/or training of CHWs who will be performing SARS-CoV-2 testing using Ag RDTs.

The package can be used in face-to-face training or as a blend of remote face-to-face training. Materials can be adapted and customized based on national guidelines and participant target groups.

Training addresses the theoretical and practical components of SARS-CoV-2 Ag RDT testing and provides CHW trainees with the skills for, and resources on, how to safely perform SARS-CoV-2 Ag RDT tests. It does not intend to address the implementation of Ag RDT testing across the diagnostic network.

The materials for the training package are freely available to download, with links to material for facilitators provided in the document.

Access training package here