COVID-19 surveillance in African Low- and Middle-Income Countries (LMICs) has been constrained by diagnostic testing capacity and gaps in coverage. Cost-effective surveillance approaches are needed to inform the targeting of clinical and epidemiological resources. A number of studies have shown it is possible to detect SARS-CoV-2 RNA in sewage, even when COVID-19 prevalence is low. Further, these studies have shown a correlation between SARS-CoV-2 concentration in sewage and the reported prevalence of COVID-19, thereby indicating that wastewater surveillance is a sensitive tool to monitor the circulation of the virus in the population. The essence of our idea is to develop wastewater SARS-CoV-2 surveillance epidemiological models that apply for African LMICs settings, consequently facilitating use of wastewater-based epidemiology to inform public health interventions.
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