For years, the LINKAGES project has worked to reduce HIV transmission among key populations and their sexual partners and to extend the lives of those already living with HIV. Now, we have joined the battle against the COVID-19 pandemic. In addition to our ongoing content about our HIV work, we are pleased to share stories and learnings from our work addressing COVID-19.
Without the ability to process COVID-19 tests, it’s difficult to know the progress of pandemic control. To facilitate COVID-19 testing services in Nepal, the Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) Nepal project is supporting national and provincial laboratories to power up for COVID-19 diagnosis.
The National Public Health Laboratory (NPHL) initiated COVID-19 real-time polymerase chain reaction (RT PCR) in January 2020 and transformed into a full COVID-19 testing lab on March 24, 2020. Taking the lead on preparing guidance, conducting trainings, and providing monitoring, supervision, and technical support, the NPHL has helped 25 laboratories in different provinces to also gradually begin RT PCR for COVID-19 to increase test-processing capabilities.
In April, LINKAGES Nepal began providing technical support to the Provincial Public Health Laboratory (PPHL) of Sudur Paschim Province and Seti Provincial Hospital at the Veterinary Disease Diagnosis Laboratory, which was chosen by the Ministry of Social Development as the COVID-19 molecular diagnostic laboratory. LINKAGES also provided onsite coaching to Dadeldhura Hospital, which is under the Ministry of Health and Population in Sudur Paschim province, to set up and initiate RT PCR for COVID-19.
LINKAGES’ technical assistance has included the development and provision of job materials, such as testing protocols for different brands of kits received from the Government of Nepal, a standard operating procedure for RT PCR kits, a flowchart on nucleic acid extraction, and temperature recording charts for the freezers and rooms. The team has also advised on staff management procedures, including working in shifts to optimize the number of tests able to be processed in one day. A substantial part of the technical assistance provided has included on-site and virtual training of 13 microbiologists, medical technologists, sample collection staff, data entry staff, and helpers. Staff were trained on:
- Preparation and use of disinfectant
- Use of personal protective equipment
- Waste management and use of the autoclave
- Molecular testing
- Cleaning and scrubbing of laboratory machines and all rooms to avoid contamination while testing
- Nasopharyngeal and oropharyngeal swab collection
- Optimum use of resources provided
- Principles of and hands-on training on nucleic acid extraction and the real-time PCR machine
- PCR results interpretation and report generation
As of August 6, 2020, Seti Provincial Hospital has tested 19,921 PCR samples and Dadeldhura Hospital has tested 3,691 samples — about 6% of the total samples tested in the country. Both sites got 100% agreement with the NPHL results during quality assurance testing. Going forward, LINKAGES will develop protocols for new brands of kits, support laboratories in PCR results analysis, and assist with virtual reporting using remote desktop software. LINKAGES Nepal will also help troubleshoot errors generated during COVID-19 testing and will coordinate with the NPHL on testing and external quality-assurance-related activities.