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. 2020 Dec 31;13(1):1841963.
doi: 10.1080/16549716.2020.1841963.

Establishment of COVID-19 testing laboratory in resource-limited settings: challenges and prospects reported from Ethiopia

Adugna Abera  1 , Habtamu Belay  1 , Aboma Zewude  1 , Bokretsion Gidey  1 , Desalegn Nega  1 , Boja Dufera  1 , Abnet Abebe  2 , Tujuba Endriyas  1 , Birhanu Getachew  1 , Henok Birhanu  1 , Hailemariam Difabachew  1 , Bacha Mekonnen  1 , Helina Legesse  1 , Firdawek Bekele  1 , Kalkidan Mekete  1 , Seble Seifu  1 , Heven Sime  1 , Nebiyou Yemanebrhan  2 , Mesfin Tefera  3 , Hiwot Amare  4 , Berhane Beyene  5 , Estifanos Tsige  6 , Adisu Kebede  2 , Geremew Tasew  1 , Getachew Tollera  7 , Ebba Abate  7 , Adugna Woyessa  1 , Ashenafi Assefa  1
Affiliations

Establishment of COVID-19 testing laboratory in resource-limited settings: challenges and prospects reported from Ethiopia

Adugna Abera et al. Glob Health Action. .

Abstract

The Coronavirus pandemic is recording unprecedented deaths worldwide. The temporal distribution and burden of the disease varies from setting to setting based on economic status, demography and geographic location. A rapid increase in the number of COVID-19 cases is being reported in Africa as of June 2020. Ethiopia reported the first COVID-19 case on 13 March 2020. Limited molecular laboratory capacity in resource constrained settings is a challenge in the diagnosis of the ever-increasing cases and the overall management of the disease. In this article, the Ethiopian Public Health Institute (EPHI) shares the experience, challenges and prospects in the rapid establishment of one of its COVID-19 testing laboratories from available resources. The first steps in establishing the COVID-19 molecular testing laboratory were i) identifying a suitable space ii) renovating it and iii) mobilizing materials including consumables, mainly from the Malaria and Neglected Tropical Diseases (NTDs) research team at the EPHI. A chain of experimental design was set up with distinct laboratories to standardize the extraction of samples, preparation of the master mix and detection. At the commencement of sample reception and testing, laboratory contamination was among the primary challenges faced. The source of the contamination was identified in the master mix room and resolved. In summary, the established COVID-19 testing lab has tested more than 40,000 samples (August 2020) and is the preferred setting for research and training. The lessons learned may benefit the further establishment of emergency testing laboratories for COVID-19 and/or other epidemic/pandemic diseases in resource-limited settings.

Keywords: COVID-19; EPHI; Ethiopia; RT-PCR; SARS-CoV-2; laboratory; pandemic.

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Conflict of interest statement

There is no conflict of interest. The authors alone are responsible for the views expressed in this publication. All authors have read and approved the manuscript.

Figures

Figure 1.
Figure 1.
Parasitology COVID-19 testing laboratory. (a) Room initial partitioning with aluminium and glass. (b) Room floor painting with epoxy for smoothening the floor for better cleaning. (c and d) extraction and master mix room in use
Figure 2.
Figure 2.
Parasitology COVID-19 testing laboratory floor design (The double lines are indicative of doors)
Figure 3.
Figure 3.
Parasitology COVID-19 testing laboratory design and workflow (PCL: Parasitology COVID Laboratory; EOC: Emergency Operation Centre): Naso/Oro-pharyngeal samples collected by trained health care professionals from risk groups, healthcare facilities, airports, border areas and communities are transported in standard triple package via cold chain to the sample reception centre. Samples allocated to PCL are received using standardized sample receiving/rejection format. Rejected samples are communicated to sample reception centre. Standard samples are given laboratory IDs and transferred to the Extraction unit. Extracted samples then transferred to master mix and detection unit where samples loaded with reagent to be detected by RT PCR machine. Results communicated to EOC through data management unit
See this image and copyright information in PMC

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