Recommendations for enhancing COVID-19 test and treat programmes in four African countries: insights and strategies from a qualitative study.

Authors

Shanti Narayanasamy, Bridget C Griffith, Sarah Gonzales, Caroline Boeke, Yamikani Gumulira, Nervine Hamza, Jessica Trenc T Joseph, Allison A Lewinski, Norman Lufesi, Alexander Martin-Odoom, Nyuma Mbewe, Elizabeth Alison McCarthy, Carl Mhina, Julie Miller, Milimo Selena Mweeba, Faustina O Mintah, Lawrence Ofori-Boadu, Rodrigue Ndayishimiye, Sean Regan, Edison Rwagasore, Krishna Udayakumar, Cameron R Wolfe, Megan M Oakes, Hayden B Bosworth, COVID-19 QuickStart Consortium

Published in

BMJ public health. Volume 4. Issue 4. Pages e004175. Epub Oct 29, 2026.

Abstract

Sub-Saharan Africa had a significant burden of infections and deaths from COVID-19. However, throughout the pandemic, the region experienced delays and more limited access to diagnostics and treatment than high-income countries. From late 2022 to 2023, nirmatrelvir/ritonavir was introduced in four sub-Saharan African countries (Ghana, Malawi, Rwanda and Zambia) in a test and treat (T&T) model. This manuscript aims to understand the perspectives of key stakeholders, Ministry of Health, public sector personnel and healthcare workers on the recommendations for improvement and strengthening of national COVID-19 T&T programmes deployed in the four study countries.
We conducted in-depth, semi-structured interviews with individuals from two key stakeholder groups: Ministry of Health or public sector personnel involved in developing and/or implementing COVID-19 T&T policy (purposive sampling) and healthcare workers involved in administering COVID-19 testing and/or treatment at study sites (convenience sampling). Sample size was driven by information power; our target sample size was 10-12 interviews per stakeholder group per country. We conducted a descriptive qualitative study to explore recommendations for improvement and strengthening of national COVID-19 T&T programmes using the Consolidated Framework for Implementation Research to guide qualitative data collection and analysis.
Four key themes were identified by key stakeholders as critical to scaling up COVID-19 T&T programmes across all study countries: increasing community education, engagement and awareness of COVID-19 and the T&T programme; adjusting the T&T programme to ensure programme integration, decentralisation and sustainability; expansion of SARS-CoV-2 testing and ensuring availability of testing kits and oral antivirals through reliable national supply chains; and ensuring ongoing training and support for healthcare workers on the COVID-19 T&T programme.
Our findings, that recommendations were largely common across countries, suggest that a unifying framework for introducing new drugs through T&T programmes during future pandemics in sub-Saharan countries may be possible, particularly when implementation strategies can be customised to fit local contexts.
NCT06360783.

PMID:
42968914
Bibliographic data and abstract were imported from PubMed on 02 Nov 2026.

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