Estimating the potential need and impact of SARS-CoV-2 test-and-treat programs with oral antivirals in low-and-middle-income countries.

Oral antivirals can potentially reduce the burden of COVID-19. However, low SARS-CoV-2 clinical testing rates in many low- and middle-income countries (LMICs) (mean <10 tests/100,000 people/day, July 2022) makes the development of effective test- and-treat programs challenging. Here, we used an agent-based model to investigate how testing rates and strategies could affect development of test- and-treat programs in three representative LMICs. We find that at <10 tests/100,000 people/day, test- and-treat programs are unlikely to have any impact on the public health burden of COVID-19. At low effective transmission rates ( R t ≤ 1.2), increasing to 100 tests/100,000 people/day and allowing uncapped distribution of antivirals to LMICs (estimate = 26,000,000-90,000,000 courses/year for all LMICs), could avert up to 65% of severe cases, particularly in countries with older populations. For higher R t , significant reductions in severe cases are only possible by substantially increasing testing rates or restricting clinical testing to those with higher risk of severe disease.