Implementing SARS-CoV-2 Routine Surveillance in Antenatal Care in Zambia, 2021-2022: Best Practices and Lessons Learned

Background Pregnant women are an easily accessible population for HIV and malaria surveillance. The ANC COVID-19 Surveillance study sought to determine SARS-CoV-2 seroprevalence among pregnant women in Zambia. We provide insight into the challenges, good practices, successes, and lessons learned from the surveillance study. Methods Between September 2021 and September 2022, 39 health facilities in four districts enrolled up to 20 pregnant women per month aged 15–49 years attending their first antenatal care visit. Consenting participants completed an electronic questionnaire and provided a blood sample for the SARS-CoV-2 antibody test. Problems and their root causes were defined and documented as they occurred. The most practical and feasible problem-solving strategies were devised, implemented, and monitored to ensure that goals were accomplished. Results Overall, 5% of the expected 9,010 SARS-CoV-2 antibody results were unavailable due to missing dried blood spot cards. The Delta and Omicron waves and the division of study districts across two different partners delayed surveillance activities. Ministry of Health staff were trained from a limited pool of health facility staff to conduct study activities. The study incurred unplanned costs for the purchase of additional kits and machine maintenance. Conclusions Incorporating SARS-CoV-2 surveillance into routine antenatal care is feasible and potentially sustainable when existing health system infrastructure, human resources, and surveillance platforms are leveraged. Yet, careful planning is needed to anticipate implementation challenges and ensure high-quality data collection.