Nucleic Acid Point-of-Care Testing to Improve Diagnostic Preparedness

Testing programs for severe acute respiratory syndrome coronavirus 2 have relied on high-throughput polymerase chain reaction laboratory tests and rapid antigen assays to meet diagnostic needs. Both technologies are essential; however, issues of cost, accessibility, manufacturing delays, and performance have limited their use in low-resource settings and contributed to the global inequity in coronavirus disease 2019 testing. Emerging low-cost, multidisease point-of-care nucleic acid tests may address these limitations and strengthen pandemic preparedness, especially within primary healthcare where most cases of disease first present. Widespread deployment of these novel technologies will also help close long-standing test access gaps for other diseases, including tuberculosis, human immunodeficiency virus, cervical cancer, viral hepatitis, and sexually transmitted infections. We propose a more optimized testing framework based on greater use of point-of-care nucleic acid tests together with rapid immunologic assays and high-throughput laboratory molecular tests to improve the diagnosis of priority endemic and epidemic diseases, as well as strengthen the overall delivery of primary healthcare services. Rapid severe acute respiratory syndrome coronavirus 2 nucleic acid tests can improve COVID-19 control, overcoming limitations with laboratory polymerase chain reaction and rapid lateral flow tests. We propose a more optimized framework for use of these technologies to strengthen management of endemic and epidemic diseases.

Automated summary

Testing programs for SARS-CoV-2 have relied on PCR laboratory tests and rapid antigen assays, but their limitations in cost and accessibility have contributed to inequity in COVID-19 testing. Low-cost point-of-care nucleic acid tests have the potential to address these issues and improve pandemic preparedness, as well as strengthen primary healthcare services.