GTA

Support: Gavi

Partners: Johns Hopkins University

Status: On-going

Objective: The objective of this project is to identify and evaluate strategies to improve the effective use of cholera rapid diagnostic tests (RDTs) that will, in turn, enhance the effective use of oral cholera vaccine (OCV). Additionally, the project aims to evaluate the use of RDTs to address critical questions regarding the deployment of RDTs and strategies for their use, ultimately improving their effectiveness towards cholera control and elimination.

Current Outcomes: In 2023, the project supported Epidemiology and Disease Control Division (EDCD) in distributing cholera RDTs to 114 Early Warning and Reporting System (EWARS) sites across the country and assisted in the development of IEC materials which were distributed along with the RDT kits. A qualitative evaluation was conducted via semi-structured interviews with 2-4 key personnel at each nested site from August to September 2023. Thirty-three interviews were done with a physician(s) and a laboratory technician(s) involved in the diagnosis of cholera and also with stakeholders at the National Public Health Laboratory (NPHL), EDCD and Department of Health Services (DOHS).

In 2024, the project supported EDCD in the Gavi application for receiving 43,600 cholera RDTs and facilitated their customs clearance. Additionally, the project supported EDCD in preparation of SOP and algorithm (flowchart) for RDT-based cholera surveillance and also worked with them to update the EWARS reporting system to better capture RDT use. Several surveys were also conducted from June 2024 to January 2025 which included “stakeholder” surveys on RDT perceptions and implementation experiences (n=20), clinical vignettes (n=24) and laboratory vignettes (n=24) to assess correct RDT implementation. In addition, there were in-depth interviews with clinicians (n=13), laboratory technicians (n=15), medical recorders (n=9), and government officials (n=13; 4 interviewed twice), PCR-based validation of RDTs in 6 EWARS sites (ECHO-N) with intensive surveillance and 6 sentinel EWARS sites (non-ECHO-N).

Other surveys included facility-level phone surveys across all provinces with one lab technician (n=94) and one clinician (n=85) surveyed from each facility to understand their experience with RDTs at their facility. Surveys were also conducted with all Provincial Public Health Laboratories (PPHLs) on RDT distribution and use (n=7). On May 21, 2025, a discussion meeting was organized to share the preliminary findings of RISE project which brought together national and international experts to review Nepal’s progress and integration efforts. Looking ahead to 2025, the final analysis of RISE project data will be completed, informing strategic planning for future RDT distribution and surveillance efforts.