COVID-19 TESTING PERFORMANCE AND STRATEGIES FOR RAPID SCALE UP OF LABORATORY CAPACITY IN A PUBLIC HEALTH EMERGENCY IN A RESOURCE-CONSTRAINED SETTING: THE SARS-COV-2 NIGERIA RESPONSE EXPERIENCEJ.

Introduction: Sufficient laboratory capacity is vital to containing infectious diseases outbreaks. This study was conducted to document the strategies adopted to scale up laboratory testing capacity during Nigeria's response to COVID-19 pandemic. Methods: This cross-sectional descriptive study adopted a mixed method approach including desk reviews and key informant interviews (KIIs). The KIIs were conducted among actors of the COVID-19 response teams in states and federal ministries of health in Nigeria. Results: At the beginning of the pandemic in Nigeria, testing performance was poor, but this improved over time. To manage the demand for testing, Nigeria adopted targeted testing with a focus on symptomatic contacts,alerts, and returning travelers from high-risk countries who were symptomatic during the quarantine period.. Strategies to enhance laboratory capacity and improve the turnaround time for results included leveraging on existing tuberculosis laboratory networks or building new laboratories where none existed; decentralization of sample collection and testing; staff health workers repurposing and hiring of volunteers; training and retraining of laboratory personnel; adoption of rapid diagnostic testing; and strengthening public-private partnerships. From an initial three laboratories with capacity to test for SARSCoV- 2 in February, 2020, the number of laboratories increased to 158 by March, 2022. Although laboratory capacity increased, logistics and supply chain disruption were still a challenge. Conclusion: Investment in local manufacturing capacities of laboratory consumables such as RDTs and reagents would promote self-reliance and sustainability for a country as populous as Nigeria.