Policy responses for Kyrgyzstan - HSRM


Policy responses for Kyrgyzstan

1.5 Testing

Currently a total of 12 state and 4 private laboratories are involved in the COVID-19 response. The quantity of the laboratories has increased. The laboratories belong to the public health system and clinical diagnostic laboratories fall under separate departments within the Ministry of Health.

The laboratories act as a network, but there is no regulatory framework describing its organizational structure, hierarchy, coordination, duties and responsibilities of every laboratory, samples and data exchange, data analysis etc. Because of this, in the peak period the network did not function effectively, and the main laboratory (the Laboratory of Virology and Molecular Genetics) appeared to be overloaded with samples for positivity confirmation which led to significant delays in results reporting and, finally, to the discontinuation of confirmatory testing.

The Ministry of Health algorithm for testing for COVID-19 envisages testing for the asymptomatic close contacts of confirmed cases, the symptomatic contacts of confirmed cases, and the suspected cases according to the WHO standard case definition. Primary care workers, medical workers in hospitals and isolation facilities and medical staff at point of entry can request testing. Tests are being performed at 8 designated PCR laboratories and in addition the Ministry of Health has designated 3 mobile laboratories to perform COVID-19 testing.

There is a national algorithm for testing for COVID-19 developed by the National Headquarters for COVID-19 that requires testing of all persons coming from “epidemiologically disadvantaged” countries, which is broader than the WHO case definition. So far, all clinical samples tested were nasopharyngeal swabs. Upon reception, samples are aliquoted and a portion is stored for further testing and confirmation, if needed.

The findings of the first stage of seroepidemiological investigation in the Kyrgyz Republic indicated a 32.5% sero-positive rate, i.e. 32,5% of the tested people have antibodies to the virus of SARS - CoV -2. In the southern regions, where the collection of blood samples from the population started one month earlier than in the rest of the country, the share of seropositive individuals    ranged from 12.5 to 15.8%. In the northern regions where blood sampling took place later, the share of seropositive people ranged from 50.8 to 62.9%.  Such a difference in the indicators can be accounted for by the fact that the southern regions started sampling the participants before the COVID peak incidence, whereas the northern regions were collecting samples right during the peak and the beginning of the disease decrease. Besides, a lower incidence was observed in the southern regions during the first rise in Coronavirus infection compared to the northern ones. This is confirmed by a more intensive increase in the current incidence in the southern regions. 

The COVID-19 alert is based on enhanced reporting from all health care levels and from the points of entry; syndromic surveillance is not carried out. Points of entry are considered as the most likely entry point of the disease into the country.

On 12 September 2020 an assessment of laboratories performing COVID-19 diagnostic testing has been conducted. The assessment was based on the WHO-LAT checklist. For the evaluation of technical capacities, a WHO technical checklist tool was piloted.

Average indicator for the laboratory core capacities
• Laboratory of Virology and Molecular Genetics 76%
• Laboratory of Virology of RCQ&EDI 80%
• Laboratory of Virology, Bishkek City 76%
• Republican Reference TB Laboratory 91%
• Regional Laboratory for COVID-19, Kant 63%
• Regional Laboratory for COVID-19, Issyk-Kul 70%
• Regional Laboratory for COVID-19, Naryn Laboratory premises under construction

COVID-19 testing capacity and capability
• Laboratory of Virology and Molecular Genetics 50%
• Laboratory of Virology of RCQ&EDI 50%
• Laboratory of Virology, Bishkek City 50%
• Republican Reference TB Laboratory 74%
• Regional Laboratory for COVID-19, Kant 43%
• Regional Laboratory for COVID-19, Issyk-Kul 48%
• Regional Laboratory for COVID-19, Naryn 50%

In case of increased sample throughput, additional laboratory specialists from other laboratories, trained to perform PCR, could be engaged for testing; this plan has been approved by the Ministry of Health.

Patient data is transmitted through an electronic system, based on immediate notification, to the next-higher level. Three times per day the Ministry of Health receives data from oblast health authorities, who get them from district level authorities and points of entry medical staff. The Ministry of Health then reports 3 times per day to the Republican Task Force that is responsible for the national coordination and management of the COVID-19 crisis.

As of 7 July 2020, the following categories are subject to testing:
1. Contacts with confirmed cases of COVID-19;
2. Persons with COVID-19 symptoms, regardless of contact with confirmed cases;
3. Health workers;
4. Non-health workers involved in the fight against COVID-19;
5. Military service personnel.

During a mission of international expert Dr Shubladze a written proposal for a national action plan was developed. It includes 8 main action lines:
• Implementation of the Action Plan for the National COVID-19 laboratory network (NCLN) for strengthening capacity of the COVID-19 laboratory testing
• Optimize the laboratory network organization for increased testing
• Building Human Resource capacity of PCR specialists
• Ensure optimal procurement for the COVID-19 laboratory network
• Ensure proper maintenance of all critical equipment
• Ensure quality management of the testing laboratories
• Ensure biosafety management of the testing laboratories
• Improve the laboratory data management