COVID-19 Specimen Collection in PNG

One Stop Shop for COVID-19 Resources

In November 2020 the Joint Agency Taskforce National Control Centre (NCC) for COVID-19 in Papua New Guinea identified the need for understanding low testing rates despite having rolled out training on swabbing for health workers across the country. Our team partnered with the NCC, World Health Organization, and Field Epidemiology Training Program in Papua New Guinea to understand from the health workers perspective why so few swabs were being collected for COVID-19.

The study was funded by the Indo-Pacific Centre for Health Security and the World Health Organization with logistics support provided by St Johns Ambulance PNG and the Global Outbreak Alert and Response Network.

Executive Summary

The overall aim of the survey was to understand from the HCWs perspective the challenges they face in swabbing patients for COVID-19 and to identify local solutions for these challenges in order to increase swabbing and improve testing rates. This exercise was led by a team from the World Health Organization’s Global Outbreak Alert and Response Network in partnership with the Papua New Guinea Joint Agency Taskforce National Control Centre for COVID-19.

Testing is an essential component of Papua New Guinea’s (PNGs) response to the COVID-19 pandemic. Testing data is vital to understand the spread of the pandemic and ensure that the response is appropriate and targeted. If testing does not occur, we will not be able to identify and isolate cases and contacts and prevent further transmission. From the start of the pandemic training on swabbing for COVID-19 has been conducted for HCWs across PNG. However, the number of swabs sent for testing remains significantly lower than the number of patients identified with reported respiratory symptoms (e.g., suspected COVID-19, influenza-like-illness, severe acute respiratory infections). As of the 31st December 41540 swabs for COVID-19 have been conducted across PNG. Monthly COVID-19 testing targets have been set for each province with a monthly target of 4656 tests nationally.

Presently, provinces are testing well below these targets. It is vital to understand the challenges and barriers that are contributing to low testing rates across PNG in order to inform targeted response measures to increase testing. Localized solutions to enhance swabbing are important to identify in order to inform appropriate recommendations that can be implemented at the local level. In order to identify barriers to swabbing and local solutions to these barriers we conducted a national telephone survey with HCWs who had been trained to collect swabs for COVID-19.

Key Findings

Survey response rate of 70.3 % (407) was achieved from the study participants. Provincial participation was 95% (21/22) with district representation of 80.9% (72/89). Respondents were predominately male, 59 % (240) and the median age was 43.4 years (ranging: 22-66 years).

Barriers

The main barriers to the collection of COVID-19 swabs mentioned by HCW included;

• Few staff trained to collect COVID-19 swabs

• Inadequate staffing at health facilities to cope with the additional burden of swabbing for COVID-19

• Inadequate supplies of personal protective equipment

• Lack of applied training and supervision in donning and doffing PPE

• Lack of refrigerators and/or cold boxes for storage of COVID-19 specimens

• Transport for specimen collection is irregular or unreliable

• Lack of logistical support for patient COVID-19 triage including infrastructure and staffing.

• Misinformation around COVID-19 in the community and among health care workers

• Stigma associated with wearing personal protective equipment

Enablers

Commonly identified enabling factors that helped facilitate HCW collecting COVID-19 swabs included;

• Community awareness / education and risk communication

• A consistent and sufficient supply of personal protective equipment and equipment needed to collect COVID-19 specimens

• Multiple staff trained on swabbing for COVID-19

• A specific area at the health centre dedicated to triage, screening and swabbing

• Recruitment of additional staff at the health centre to focus on COVID-19 related activities such as triage and swabbing

• Provision of refrigerators and/or cold boxes for storage of COVID-19 specimens

• Availability of reliable and regular transport for specimen collection

• Outreach programs with a focus on creating awareness around COVID-19 and the collection of specimens

Recommendations

1. Roll out refresher and additional training to the provinces on swabbing and the use of PPE, with focus on the district and rural health facilities. Training should be applied and practical with supervision on correct technique. Participants should feel confident to collect swabs and use PPE safely at the end of the training

2. Develop a community engagement plan for advocacy meetings and awareness, health promotion and risk communication at all levels

3. Integrate COVID- 19 surveillance and response activities into the existing public health programs at the national, provincial and district levels

4. A regular supply chain with close monitoring of stock at all levels and timely replenishment. No health facility should experience stock out of PPE or equipment needed for swabbing

5. Procurement of standardized fridges, cool boxes/eskies and triage tents and prioritize the need per province

6. Develop an organizational structure and mechanisms to ensure adequate staffing and funding to respond adequately and manage future emergencies/ outbreak at the national and provincial levels