The challenges of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing in low-middle income countries and possible cost-effective measures in resource-limited settings

Abstract

Diagnostic testing for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection remains a challenge around the world, especially in low-middle-income countries (LMICs) with poor socio-economic backgrounds. From the beginning of the pandemic in December 2019 to August 2021, a total of approximately 3.4 billion tests were performed globally. The majority of these tests were restricted to high income countries. Reagents for diagnostic testing became a premium, LMICs either cannot afford or find manufacturers unwilling to supply them with expensive analytical reagents and equipment. From March to December 2020 obtaining testing kits for SARS-CoV-2 testing was a challenge. As the number of SARS-CoV-2 infection cases increases globally, large-scale testing still remains a challenge in LMICs. The aim of this review paper is to compare the total number and frequencies of SARS-CoV-2 testing in LMICs and high-income countries (HICs) using publicly available data from Worldometer COVID-19, as well as discussing possible interventions and cost-effective measures to increase testing capability in LMICs. In summary, HICs conducted more SARS-CoV-2 testing (USA: 192%, Australia: 146%, Switzerland: 124% and Canada: 113%) compared to middle-income countries (MICs) (Vietnam: 43%, South Africa: 29%, Brazil: 27% and Venezuela: 12%) and low-income countries (LICs) (Bangladesh: 6%, Uganda: 4% and Nigeria: 1%). Some of the cost-effective solutions to counteract the aforementioned problems includes using saliva instead of oropharyngeal or nasopharyngeal swabs, sample pooling, and testing high-priority groups to increase the number of mass testing in LMICs.

Keywords: Cost-effective strategies; Diagnostic testing challenges; Low-middle-income countries; Resource-limited settings; SARS-CoV-2.

Fig. 1

Prisma flow chart for SARS-CoV-2 literature articles and data search strategies

Fig. 2

The number of SARS-CoV-2 tests (%) performed in high-income and middle-low-income countries and these samples represents counties of each income group. High-income countries are highlighted in red, middle-income countries are highlighted in yellow, and low-income countries are highlighted in green [10]. High-income countries (USA, Switzerland, Australia, Canada, Germany). Middle-income countries (Venezuela, Vietnam, South Africa, Brazil). Low-income countries (Bangladesh, Uganda, Nigeria)

Fig. 3

Comparison between the total population size (million) and the total number of SARS-CoV-2 tests performed (million) in each country [10]. High-income countries (USA, Switzerland, Australia, Canada, Germany). Middle-income countries (Venezuela, Vietnam, South Africa, Brazil). Low-income countries (Bangladesh, Uganda, Nigeria)

Fig. 4

A summary of the major challenges that LMICs have when it comes to SARS-CoV-2 testing, as well as possible cost-effective strategies for increasing mass testing