Evaluating the planning for and distribution of cholera rapid diagnostic tests in Nepal

Background Cholera remains a significant public health threat in many low- and middle-income countries (LMICs). Rapid diagnostic tests (RDTs) offer a promising tool for improving surveillance and timely response, particularly as programs like Gavi’s Diagnostics Support Platform expand access. To realize the full potential of RDTs, effective national distribution strategies are essential. Objective This study aimed to document lessons learned from Nepal’s first government-led, large-scale distribution of cholera RDTs in 2024, to inform successful strategies for national and global scale-up. Methods We conducted a mixed-methods evaluation of the 2024 cholera RDT rollout in Nepal. Data collection included quantitative surveys with laboratory technicians and clinicians from health facilities, provincial public health laboratories (PPHLs), and government stakeholders. In-depth interviews were conducted with clinicians, laboratory technicians, medical recorders, and government officials to explore implementation experiences. Results Nepal’s experiences rolling out cholera RDTs offer important lessons in supply chain management. Procurement : Support from Gavi and technical partners was vital for securing RDTs. Opportunities exist to simplify application processes, and delays should be anticipated. Importation : Timely coordination with the Ministry of Finance was necessary to obtain duty exemption certificates and avoid customs fees. Surveillance site selection : Facilities selected for RDT distribution needed both reporting mechanisms and connections for confirmatory testing. However, extending RDTs to lower-level, rural facilities is important for greater impact. Demand forecasting and stock management : Allocation decisions benefited from combining surveillance data with local knowledge. Rigorous and systematic data on RDT usage can inform forecasting for future years. Stock tracking systems and redistribution mechanisms are critical to preventing both stock-outs and wastage. Distribution pathway : Provincial-led distribution and stockpiles facilitated rapid delivery and responsiveness. Shipping : Coordinating RDT shipments with other supplies and standardizing delivery procedures is important for efficiency. Training and Communication : In-person training and clear communication on both RDT use and distribution across all levels of government and health facilities facilitate implementation. Conclusion Nepal’s experiences provide practical, transferable lessons on cholera RDT distribution that can guide similar efforts in other cholera-endemic countries.