Fighting antimicrobial resistance through connected diagnostics

Editor's note: This is the third article in a four-part series. Read the first and second article here.

Antimicrobial resistance (AMR) is one of the top 10 global health threats facing humanity, according to the World Health Organization (WHO). AMR occurs when bacteria, viruses, fungi, and parasites mutate and no longer respond to medicines. As a result, infections become harder to treat and the risk of disease spread, severe illness, and death increases.

Experts estimate that by 2050, AMR-related deaths could grow to 10 million per year—unless AMR is curbed. With connected diagnostics, countries can build national disease surveillance systems that are better able to monitor, detect, and address AMR.

Disease surveillance is an integral part of AMR prevention, response, and control. But disease surveillance systems are only as robust as the laboratory networks supporting them.

WHO highlights strengthened national health laboratory systems as an effective means to “improve clinical and public health services … for better preparedness for, surveillance of and response to epidemic-prone diseases, health security issues and other potential emergencies of public health concern.”

To address AMR, national surveillance systems require three core components—a national coordinating center, a national reference laboratory, and one or more AMR surveillance sites. Reliable and timely results from laboratory investigations are at the center of all critical public health decisions and responses.

Connected diagnostics can help strengthen each of these core areas by improving the quality and accessibility of medical diagnostic data at surveillance sites, streamlining the processes for data sharing and interpretation, and supporting automated alerts, which trigger prompt control measures to contain potential outbreaks when reported cases of a specific disease exceed a predefined threshold.

PATH has decades of experience advancing diagnostic capacity and disease surveillance in low- and middle-income countries (LMICs), specifically through interoperable dashboards that monitor disease trends, including AMR.

The Infectious Disease Detection and Surveillance (IDDS) project, funded by the US Agency for International Development and implemented by an ICF-led consortium with PATH as a technical sub partner, is working to strengthen national and subnational diagnostic networks and surveillance systems in countries where data on pathogens of public health importance are typically sporadic or seldom shared with national health information systems.

In Tanzania, for example, hospital laboratories were not capturing AMR surveillance because their laboratory information management systems (LIMS) had limited surveillance functionalities. To address this, the IDDS project has been working closely with the National Public Health Laboratory in Dar es Salaam to perform tests that detect AMR in four designated hospitals.

The IDDS project also helped harmonize and integrate LIMS data from the four testing sites into the WHO’s microbiology laboratory database (WHONET).

“Laboratory performance practices and improvements have been remarkable,” said Bachana Rubegwa, an IDDS AMR-Advisor in Tanzania.

Laboratory personnel, pharmacists, nurses, clinicians, and other members of the hospital community now meet regularly for clinical sensitization, mentorship, and support. Quarterly meetings review AMR data quality specifically.

“Antibiotic prescription practices and patient outcomes have also improved thanks to hospital-specific antibiograms that guide the selection of appropriate antibiotics,” Rubegwa said.

Preliminary lessons from the IDDS project show that political will to invest in laboratory systems and innovations is pivotal to further strengthening the global agenda to curb AMR.

For instance, if automated and data-driven alarm mechanisms that trigger outbreak investigations are to become a reality, governments will need to invest in training laboratory staff and modernizing information technology (IT) systems.

Scaling up AMR surveillance systems will also require the development of national digital strategies that address data sharing, interoperability, and data security issues.

“Authorities need to understand that data sharing and data safety go beyond AMR and IDDS,” Rubegwa said. “These are national security issues.”

Prioritizing, investing, and building connected and collaborative national systems can also benefit regional disease surveillance capabilities, subsequently reinforcing the pillars for effective detection and control of pathogens of public health significance, like AMR, at a more global scale.

While the advantages of connected diagnostic systems are apparent from a disease surveillance perspective, access to high-quality and timely laboratory services are disproportionately low in LMICs. This makes it difficult for many LMICs to detect and respond to known and new infectious disease threats, including AMR.

Moreover, increased connectivity in the diagnostics field does not always have the expected benefits and impact at all levels of the health system.

The next article in PATH’s Connected Diagnostics series discusses the prerequisites and preconditions necessary for a connected system in more resource-constrained settings.

Learn more about PATH’s work in diagnostics.