In response to the global threat of anti-microbial resistance (AMR) the Fleming Fund was established in 2015 to assist low and middle income countries (LMIC) in developing surveillance systems and laboratory capacity. CRU conducted three initial complementary scoping studies to help funding partners identify areas of greatest need and how best to strengthen surveillance capacity.
1. An analysis of approaches to laboratory capacity strengthening for drug resistant infections in low and middle income countries.
The purpose of this study was to identify and compare in broad terms laboratory capacity strengthening models in LMICs, focusing on enablers and barriers to success in relation to AMR surveillance in different contexts.
A systematic review of published and grey literature was conducted to identify laboratory strengthening models, supplemented by consultations with contacts in LMICs and relevant research and development organisations. The strengths and weaknesses of each laboratory capacity strengthening model were assessed against a study-specific evaluation matrix. Models were compared and contrasted according to the evaluation matrix, including identifying contexts where each model has been successful and presenting barriers and enablers present in different contexts.
2. AMR surveillance models in Ghana, Nigeria and Nepal
Building on the above analysis, this study compared antimicrobial surveillance systems in three LMICs in order to describe the components of these systems and to understand which surveillance models are best suited to particular contexts. In-country teams each visited four laboratories covering the private and public sector and tertiary and secondary facilities. They used the same tools, which were based on international guidelines, so that AMR surveillance systems and laboratory quality could be compared among the countries and laboratories.
The AMR surveillance systems were at different stages of maturity and none had a national electronic AMR information system. National AMR surveillance plans were being finalised in two countries and only one had a national coordinating centre for AMR surveillance. In two countries AMR surveillance was limited to specific diseases and AMR surveillance activities relied on external funding. No country had an internationally accredited national AMR reference laboratory. Examples of interesting initiatives included inter-hospital collaborations on AMR and quality monitoring of antimicrobials.
3. Supporting surveillance capacity for antimicrobial resistance: Regional Networks and Educational Resources
The study objectives were to identify and describe drug resistance surveillance networks in LMICs and available educational resources that could support effective implementation of such networks. Surveillance networks and educational resources were identified through literature searches and individuals involved in such networks. Telephone interviews were conducted with key individuals associated with AMR surveillance networks. Twenty regional and international AMR surveillance networks were identified, in addition to several research networks involved in AMR surveillance. A limited number of educational resources relevant for supporting AMR surveillance which are freely accessible on-line were also identified.
These three studies are independent studies commissioned by the Wellcome Trust and funded by Department of Health as part of the Fleming Fund.