Background: COVID-19 RDT Testing In Ekiti State

Ekiti State recorded its first confirmed & probable cases of COVID-19 on 18th of March, 2020. The State molecular laboratory was commissioned on June 1st, 2020 after accreditation by the Nigeria Centre for Disease Control (NCDC). Active case finding and community testing across the 16 LGA commenced on the 1st of July 2020. Covid-19 Ag RDT testing commenced in the State on 19th April, 2021. Ekiti state has about 198 Covid-19 RDT testing sites in public and private health facilities. 

Bill and Melinda Gates Foundation (BMGF) Project

The Bill & Melinda Gates Foundation (BMGF) Project commenced in Ekiti state on 21st February, 2022 and ended on 5th May, 2022). Testing for COVID-19 is key to understanding the burden and trajectory of the pandemic that happened in February 2020, especially with the emergence of new variants of concerns (VOC). Improving and increasing testing capacity is a key strategic priority for the Nigeria Centre for Disease Control (NCDC), specifically in building surge capacity for antigen testing (Rapid Diagnostic Tests-RDTs).

The African Field Epidemiology Network (AFENET), in collaboration with the Nigeria Centre for Disease Control (NCDC) with funding support from Bill and Melinda Gates foundation (BMGF) implemented a project titled: COVID-19: Nigeria – Increase testing capacity. This project directly supported Ekiti State to build surge capacity for rapid antigen testing, and helped the State to prepare for future waves of the COVID-19 outbreaks.

Aim and Objectives Of The Project

While the aim is to support the improvement and increment in surge capacity for COVID-19 testing towards COVID-19 pandemic prevention and containment in Ekiti State, the objectives include:

  1. To build subnational capacity for COVID-19 antigen RDT testing in 16 LGAs in the State through training and supportive supervision for field testing
  2. To expand access to quality COVID-19 testing in targeted communities and settings
  3. To ensure real time integration of COVID-19 rapid diagnostic data into SORMAS.
  4. To provide surge support for response if local outbreaks are identified from COVID-19 rapid testing.
  5. To improve COVID-19 average sample result and TAT at national level and in the State.

Proposed Outcomes From The Project

  1. Increased COVID-19 point of care diagnostic testing capacity at sub-national level.
  2. Improved detection of local outbreaks of COVID-19 in vulnerable communities and congregate settings and prompt response
  3. Improved epidemiological profiling of the COVID-19 pandemic for more effective evidence-based decision making in the response.
  4. Increased SARS-Cov-2 genomic sequencing capacity of NRL and the BSL3 laboratory and biobank

Methodology

State Mobilisation Strategies

Letters were written through Medical and Health Officers and Health Supervisors at Local Governments and Ministries to the Head of Service (HOS), who gave a mandate to Heads of MDAs and Institutions to allow civil servants, Health Workers (HWs), teachers and students of Secondary and Tertiary Institutions to participate in surge testing. Communities, markets, and correctional centres were also targeted. Community members were mobilised by 3 community mobilizers per team. Community leaders, religious leaders and traditional leaders were also mobilised. 

Engagement meeting was held with Risk Communication Pillar in the State and LGAs to give State wide awareness and sensitization of the project to the Schools, HWs and Public places such as Markets, Churches etc. Relevant Emergency Operation Centre (EOC) Pillars were incorporated e.g. Risk Com, Logistics, Case management, vaccination etc. to the meeting.

A logistic company was hired to ensure undeterred standby vehicles were provided for the team members to convey them daily to their respective locations. A proposal was written to the World Health Organization (WHO) for State and LGA team support to boost COVID-19 vaccination and sensitization. With this approval, vaccination teams were integrated with the surge testing teams. The WHO Ekiti team was able to support the State with:

  • One (1) vaccination team per testing team daily.
  • Three (3) town announcers per team.
  • One (1) Recorder with data bundle.
  • Sixteen (16) LGA DSNOs, 16 LGA Health Educators and LIOs.
  • Security escorts for security compromised areas.
  • The State Team included SDSNO, Logistic Team Lead, SIO, CCO and the two State Health Educators.
  • 1,500 PPEs and two (2) sanitizers per team.

Intense monitoring and supervision of the teams were done by the State and National teams.

Team Distribution

Seven (7) project teams were deployed. Teams consist of 2 Testers, 2 Data clerks and one Team lead (total of 35 team members). Each team was to test between 150-200 clients/day, making a total of 52,500-70,000 tests in 50 days for the State (each team to test 7500 over the 50 days intensive period).

LGAs Covered

All the 16 Local Government Areas (LGAs) in the State were covered:

  • Team 1 – Three LGAs (Ido/Osi, Ilejemeje & Moba)
  • Team 2 – Four LGAs (Ekiti West, Ijero, Efon & Ekiti South West)
  • Team 3 – Three LGAs (Ikere, Ise/Orun & Emure)
  • Team 4 – Three LGAs (Gbonyin, Ekiti East & Ikole)
  • Team 5 – One LGA (Ado)
  • Team 6 – Two LGAs (Irepodun/Ifelodun & Oye)
  • Team 7 – One LGA (Ado)

RDT Inventory 

The total RDT supplied to the State during Surge was 70,000, and the RDT utilized was 59119. All RDTs utilized during the Surge tests have been reported on SORMAS, while the unused RDT Kits have been returned to the Ministry of Health’s Store.

Results

The total number of people tested in the Surge Project as of 30th April, 2022 was 59,119. The total number of confirmed positive cases was zero, while the number of false positives and actions taken was 103, confirmed later using PCR technology.

Sustainability Plan

The State has a total of about 205 facility-based COVID-19 testing sites across all LGAs where COVID-19 tests are being carried out across the State in all arms of healthcare with RDT kits distributed. These facilities cut across the following: Primary Healthcare, Secondary healthcare, Tertiary healthcare and Private facilities

There are systems in place for reporting their data and also weekly Emergency Operation Centers (EOCs) meetings at the LGA level are being conducted per LGA currently with reports shared with the State EOC. The State Rapid Response Team is also on ground to support the LGA RRT for rapid outbreak investigation and response.  This structure is geared towards improving the testing capacity and ensuring rapid response to COVID 19 cases in the State.

Major Challenges

The major challenges encountered during the project include delay in accessing RDT kits and inadequate supply of PPE from NCDC; fuel scarcity hindering planned movement of teams to hard-to-reach/remote areas; hesitancy in the communities, mostly by vaccinated individuals; SORMAS downtime issues delaying prompt reporting of data, and; tertiary institutions not being covered because of the ongoing ASUU strike.

Key Outcomes from the Project

  1. The exercise enabled the State to have more people to get tested and the engagement was able to broaden the horizon on COVID-19. The project also helped to ramp up covid-19 vaccination.
  2. The project also gave the community people a sense of belonging as the tests and vaccination were brought to their doorstep. In some communities in Ido/Osi LGA, the testing was also accompanied by free BP tests.
  3. With the number of tests conducted and the bases covered, given negative results on all cases, positive cases were zero at the time of test in the State.

Recommendation

Ekiti State should be selected for any laudable project like this by the AFENET/NCDC in their subsequent project having met the target, conducted a very successful exercise and achieved all the set objectives.

Original Article by:
Bosede Alowooye, State Epidemiologist, Ministry of Health and Human Services, Ekiti State. 

Edited by:
Tayo Fasuan, Chief Research and Communication Officer, MicroBiotics.

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