Background:Probable cases of Covid-19 with in districts have to be refered or transported to designated facilities to collect samples amidst an on-going country wide lockdown. This is increasingly becoming a challenge as the number of people refered is increasing and the resources available to facilitate transport are redcuing. This is further compounded by an increase in the turnaround time currently reported at at least five days for results to return from the central testing laboratory. These coupled have increased anxiety in the commnityand a loss of trust in the system, affecting government efforts of Covid-19 case detection. The DHOs therefore seek evidence to contribute to on-going discussions with the national task force on the scale-up of the response to the covid-19 outbreak in Uganda. for example how to leverage available laboratory networks within districts to scale-up the frequency of testing. Question:What are the considerations for strengthening districts laboratory systems and networks in the scale-up ofresponse for COVID-19 in Uganda?Findings:The on-going COVID-19 outbreak has a high rate of transmissibility and impact on communities and the health system. Therefore, all countries will, at some point, need to scale up the frequency of testing samples. To strengthen national laboratory systems and networks, nations use information on the available resources, stage of the outbreak and availability of innovative diagnostics, e.g. rapid diagnostic tests and Gene Xpert modules. From previous experiences of past outbreaks such as Ebola, countries can consider taking the following actions to facilitate a scale-up of their response: ï¶ Mobilise a significant amount of resources, including trained and well-motivated personnel and physical infrastructure and guided by capable management and leadership. ï¶ Review of the national laboratory policy and ensure this fits in the long term plans to strengthen laboratory systems. ï¶ Conduct a risk assessment of the existing laboratory infrastructure, personnel and practices. The assessment ensures consistency with the updated international health regulations 2005 (IHR) for biosafety and biosecurity. ï¶ Assess and strengthen the capacity of the specimen transportation networks and ensure this maintains biosafety and biosecurity guidelines; confidentiality and privacy of individuals.ï¶ Build capacity of ALL the personnel in good laboratory practices, biosafety and biosecuritypractices. Ensure that personal protective equipment are available and used all the time.ï¶ Ensure availability of standardised protocols to comply with IHR 2005 and for the pathogens to be tested at the laboratoryï¶ Provide continuous technical assistance, supervision and monitoring of the peripheral laboratories.ï¶ Review communication channels between the care and laboratories and ensure that there is an open, transparent and available mechanism for communication and information transfer.ï¶ Ensure there is a robust quality control system according to national policies and standards. ï¶ Facilitate partnerships and cooperation between laboratories. Conclusion: Governments, especially those of low-income countries, need to scale up the testing and identification of probable cases of Covid-19 in situations where clusters or community transmissions havebeen confirmed. Scaling up laboratory systems will involve mobilising a significant amount of resources, reviewing national policies for laboratory systems, building the capacity of all personnel and transportation networks and taking advantage of innovative diagnostics made available to improve testing.
