The coronavirus disease 2019 (COVID-19) has challenged health systems globally. In low and middleincome countries, a unique challenge ensuring the widespread testing that is critical to the response toward the pandemic has persisted. The pandemic has accentuated the need for rapid scale-up of real-time polymerase chain reaction (RT-PCR), a molecular testing technique that was often used for research purposes only, especially in limited-resource settings. Rwanda is a lowincome country that has managed to scale up RT-PCR laboratory testing capacity by 15-fold within the first four-month of the COVID-19 pandemic. Rwanda has been in line with the measures to contain COVID-19 even before 14th March 2020, when the first case of COVID-19 was detected. Due to the transmission of the infection, the scale-up was immediately in place, relying on public, private, nongovernmental, and voluntary students from universities to boost the surveillance of the pandemic in the population. In COVID-19 testing, this scale-up relied on population and government goodwill; research-based actions that included adopting a pooling strategy; optimized use of available human resources; and the use of limited resource funding models to support the established health system governance structure. Initially, the national reference laboratory was the only testing site for COVID-19; however, later, the country implemented decentralized testing, setting up COVID-19 testing centers countrywide. In this article, we highlight the lessons learned from the Rwandan COVID-19 laboratory testing response to guide effective laboratory response in limited-resource settings. We recommend an appropriate epidemic response algorithm to be developed to classify cases based on epidemiological, clinical, and laboratory information in line with diagnosis methods and sustain quality.

Keywords : NCOVID-19, SARSCOVI-2, SCALING UP, RTPCR, RWANDA