BACKGROUND: COVID-19 test-and-treat programs have the potential to save lives and protect fragile health systems, particularly when integrated horizontally. The COVID Treatment QuickStart Consortium partnered with 10 countries to accelerate access and introduce oral antivirals such as nirmatrelvir/ritonavir. We present here the model of integrating COVID-19 test-and-treat within the University Teaching Hospital (UTH), including the Adult Infectious Disease Center (AIDC) in Lusaka, Zambia, after 1,000 courses of donated nirmatrelvir/ritonavir arrived on December 22, 2022.
DESCRIPTION: Client flow for COVID-19 at UTH involves conducting rapid antigen testing for symptomatic clients presenting for care in any department. Eligibility criteria for oral antivirals in Zambia requires positive SARS-CoV-2 clients to meet the following criteria: high-risk (e.g. age 50+, people living with HIV (PLHIV), and other conditions), mild/moderate disease, and presenting within five days of symptom onset. COVID-19 oral antivirals are then prescribed by trained clinicians and dispensed from the TB/COVID clinic or emergency pharmacy. For PLHIV, bidirectional screening occurs for COVID-19 and TB; testing, prescribing, and drug dispensing all happens within AIDC.
LESSONS LEARNED: Between December 24, 2022 and April 30, 2023, out of 7,125 tests, 290 (4.1%) clients had positive SARS-CoV-2 tests at UTH, 9% of which were HIV-positive or from AIDC. Nirmatrelvir/ritonavir was prescribed to 84% of these clients. Median age was 37 years, 61% were female, and 69% were previously vaccinated. Bidirectional screening at AIDC helped identify clients with diabetes and hypertension, and AIDC is now adopting this as standard-of-care. Integration of screening and updated training models to include a team approach increased acceptability amongst health workers.
CONCLUSIONS: Zambia was one of the first countries in Africa to prescribe nirmatrelvir/ritonavir to SARS-CoV-2 positive PLHIV. The quick roll-out succeeded because of strong leadership from the Zambian Ministry of Health and public-private partnerships. UTH has demonstrated the feasibility of integrating COVID-19 services into all hospital entry points, with a focus on high-risk clients such as PLHIV attending AIDC. Nirmatrelvir/ritonavir has subsequently been integrated into routine services at ten other facilities throughout the country. Overall lessons learnt will enable further scale-up—both within Zambia and in other African countries—and allow for further learnings of integrated test-and-treat programs.

Download the e-Poster (PDF)