A multistage mixed-methods evaluation of the UKHSA testing response during the COVID-19 pandemic in England

IntroductionIn 2020, the UK Health Security Agency (UKHSA) established a large-scale testing programme to rapidly identify individuals in England who were infected with SARS-CoV-2 and had COVID-19. This comprised part of the UK governments COVID-19 response strategy, to protect those at risk of severe COVID-19 disease and death and to reduce the burden on the health system. To assess the success of this approach, UKHSA commissioned an independent evaluation of the activities delivered by the NHS testing programme in England. The primary purpose of this evaluation is to capture key learnings from the rollout of testing to different target populations via various testing services between October 2020 and March 2022 and to use these insights to formulate recommendations for future pandemic preparedness strategy. Methods and analysisThe proposed study involves a stepwise mixed-methods approach, aligned with established methods for the evaluation of complex interventions in health, with retrospective and prospective components. A bottom-up approach will be taken, focusing on each of nine population-specific service settings. We will use a Theory of Change to understand the causal pathways and intended and unintended outcomes of each service, also exploring the effect of context on each individual service settings intended outcomes. Subsequently, the insights gained will be synthesised to identify process and outcome indicators to evaluate how the combined aims of the testing programme were achieved. A forward-looking, prospective component of this work will aim to inform testing strategy in preparation for future pandemics, through a participatory modelling simulation and policy analysis exercise. DisclaimerThis is a provisional draft protocol that represents research in progress. This research was commissioned and funded by UKHSA, to be performed between August 2022 and March 2023. The scope and depth of testing services and channels covered by this research were pre-agreed with UKHSA and are limited to the availability and provision of data available at the time this protocol was written. Ethics and disseminationFindings arising from this evaluation will be used to inform lessons learnt and recommendations for UKHSA on appropriate pandemic preparedness testing programme designs; findings will also be disseminated in peer-reviewed journals and at academic conferences. Strengths and limitations of the studyO_LIStrengths of this mixed-methods evaluation protocol include the use of theory-based, complex evaluation approaches and an iterative and participatory approach with the stakeholder (UKHSA) to the evaluation process and prospective modelling. C_LIO_LIGiven the scale and complexity of the COVID-19 testing response in England, there is a scarcity of previous relevant research into this, either in England or appropriate international comparators, warranting the mixed-methods evaluation approach we are adopting. C_LIO_LIThis is the first national-scale evaluation of the testing response to COVID-19 in England to incorporate most service settings, a programme which formed an integral part of the UK pandemic response strategy. The approach proposed could be applied to the evaluation of pandemic responses in other contexts or to other types of interventions. C_LIO_LIWhereas most complex interventions are accompanied by a prospective evaluation design initiated at the time of the intervention or earlier, this study predominantly comprises a retrospective evaluation and is therefore limited by the quality of existing research and the data available to the research team at the time of conducting the evaluation within the specified period allocated by UKHSA. C_LI

The potential health and economic impact of dexamethasone treatment for patients with COVID-19

Dexamethasone has been shown to reduce mortality in hospitalised COVID-19 patients needing oxygen and ventilation by 18% and 36%, respectively. Here, we estimate the potential number of lives saved and life years gained if this treatment would be rolled out in the UK and globally, as well as its cost-effectiveness of implementing this intervention. We estimate that, for the UK, approximately 12,000 [4,250 - 27,000] lives could be saved by January 2021. Assuming that dexamethasone has a similar effect size in settings where access to oxygen therapies is limited, this would translate into approximately 650,000 [240,000 - 1,400,000] lives saved globally. If dexamethasone acts differently in these settings, the impact could be less than half of this value. To estimate the full potential of dexamethasone in the global fight against COVID-19, it is essential to perform clinical research in settings with limited access to oxygen and/or ventilators, e.g. in low and middle-income countries.