Zambia was the first QuickStart country to start test and treat using donated Nirmatrelvir/ritonavir for high-risk COVID-19 patients. In a recent visit to Lusaka, Zambia for the 3rd Conference on Public Health in Africa (CPHIA), representatives from the Clinton Health Access Initiative (CHAI) and Duke University visited the Zambia University Teaching Hospital (UTH). UTH was the first facility in Zambia to offer COVID-19 test and treat services and also served as a warehouse[1] and an initial treatment distribution point, during COVID-19 surges, to other facilities.
At the hospital, the visiting team was welcomed by the Director of Infectious Diseases, Ministry of Health and Zambia National Public Health Institute officials, representatives from the CHAI Zambia office, and clinical and pharmacist staff at UTH.
COVID-19 test and treat access points
The Chest Clinic, open for outpatient services from 0800Hrs to 1600Hrs, is the main access point for COVID-19 test and treat. Patients suspected to have contracted COVID-19 present themselves to an outdoor triage area where testing for tuberculosis (TB), COVID-19, and HIV is done. COVID-19 and HIV tests are performed using rapid test kits and results are released immediately to the patients, while TB screening is done through the polymerase chain reaction (PCR).
Patients who test positive for COVID-19 are examined by a who assess treatment eligibility. Eligible patients are prescribed nirmatrelvir/ritonavir.
Out-patient COVID-19 test and treat services are also offered at the Accidents and Emergency (A&E) Unit which operates 24 hours. The pharmacy at the A&E unit is stocked with nirmatrelvir/ ritonavir to facilitate access to the oral antivirals for clients who need the services outside the chest clinic’s operating hours. COVID-19 testing is undertaken at a triage near the unit’s pharmacy to limit interaction with other patients. Other clinics that offer COVID-19 testing services include the HIV clinic and the non-communicable diseases clinics. COVID-19 positive patients are referred to the chest clinic for further consultation and linkage to care.
Lessons learned from the visit
From the visit, the team learned that some of the key enablers that have led to a successful COVID-19 testing services include the HIV clinic and the non-communicable disease clinics. COVID-19 positive patients are referred to the chest clinic for further consultation and linkage to care.
Looking forward
After the tour of the COVID-19 test and treat access points, the team discussed with the Ministry and UTH team on the future of the COVID-19 test and treat program and its sustainability. Looking forward, efforts will be directed towards program implementation documentation and dissemination including convening joint learning sessions within Zambia and across other QuickStart Countries. The program will also undertake an economic evaluation to establish the cost of implementing a COVID-19 test and treat program. The Zambia Ministry of Health and the National Public Health Institute also plan to conduct research to better understand long COVID.
[1] The Ministry of Health authorizes the designation of a facility as a warehouse and a distribution point for medical products.