Decentralizing testing capacity of mpox in Africa: a narrative review

Decentralized diagnostics are essential for the timely detection and control of mpox outbreaks. Burundi and the Democratic Republic of Congo (DRC) transitioned from centralized testing to decentralized models using GeneXpert platforms, mobile labs, and real-time feedback systems. Burundi expanded from one to 56 diagnostic sites, reducing site-level turnaround times to 2-4 h and achieving nearly 100% testing coverage. The DRC scaled up from 2 to 28 labs, deploying multiplex platforms and stabilizing testing rates. Genomic surveillance also advanced, with over 3000 mpox virus (MPXV) genomes sequenced across 23 countries, revealing new clades and informing public health responses. Africa reached the 8% sequencing threshold, enabling real-time viral tracking. The mpox epidemic accelerated reforms, including continental guidelines for laboratory decentralization and the launch of a new initiative to expand testing, training, and local manufacturing. This article describes the mpox laboratory decentralization efforts, achievements, lessons, and best practices across Africa.