Factors Influencing the Rollout and Uptake of COVID-19 Rapid Diagnostic Testing: Qualitative insights from Six African Nations

Patrick A. Njukeng^1,2*Charles Njumkeng^1,3Prudence Tatiana Nti Mvilongo¹Elvis T Amin¹Akemfua Fualefac^1,2Serge Raoul Ekukole Ekome¹Mahamat Nadjib Abderahim⁴Lethso Thibaut Ocko Gokaba^1,5Ousmane Sani⁶Bandaogo Ousséni⁷Alusine Fofana⁸Evans Ngha KAH⁹Kekeletso Kao¹⁰

• ¹Global Health Systems Solutions, Douala, Cameroon
• ²Department of Microbiology and Parasitology, University of Buea,, Buea, Cameroon
• ³Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
• ⁴Faculté des Sciences de la Santé Humaine, Université de N'Djamena, N'Djamena, Chad
• ⁵Faculté des Sciences de la Santé, Université Marien Ngouabi, Brazzaville, Republic of Congo
• ⁶Centre de Recherche Médicale et Sanitaire, Niamey, Niger
• ⁷Institut National de Santé Publique (Burkina Faso), Ouagadougou, Burkina Faso
• ⁸Ministry of Health and Sanitation (Sierra Leone), Freetown, Sierra Leone
• ⁹University of Yaounde I, Yaounde, Centre, Cameroon
• ¹⁰Foundation for Innovative New Diagnostics, Geneva, Geneva, Switzerland

The COVID-19 pandemic has profoundly affected healthcare systems in Africa, revealing urgent Challenges in resource-limited settings and the need for effective diagnostic strategies. This study examines the factors influencing the rollout and uptake of COVID-19 antigen-based rapid diagnostic tests (Ag-RDTs) in six African countries: Cameroon, Chad, Burkina Faso, Niger, Sierra Leone, and the Republic of Congo. Utilizing qualitative methodologies, we conducted focus group discussions (FGDs) with healthcare personnel, community health workers, and community members to explore barriers and facilitators affecting decentralized testing efforts. Key barriers identified include misinformation, distrust in government intentions, staff demotivation, and stigma surrounding positive test results. In contrast, facilitators such as community engagement, short turn around turn, international travel requirement and the involvement of community health workers in testing process emerged as strong motivators for testing uptake. Findings emphasize the critical importance of coherent communication strategies and community sensitization efforts to combat misinformation and foster acceptance of testing. Moreover, Integrating COVID-19 testing into routine healthcare surveillance and strengthening community health systems through capacity building are essential for improving overall public health responses. Stakeholders highlighted government policies, including public awareness campaigns, Media engagement and decentralisation of testing services, as essential in improving testing coverage. This study underscores the need for targeted interventions that respect local contexts, enhancing the resilience and strength of healthcare systems and pandemic preparedness in Africa against current and future public health challenges.