Challenges

Antimicrobial resistance (AMR) is a major public health problem and development issue because, in addition to its impact on morbidity and mortality, it has a huge economic impact. Accurate, reliable and timely laboratory testing for AMR is an essential component of effective disease surveillance, prevention and management.

The capacity for the detection of AMR is heterogeneous within CARICOM Member States, as are the susceptibility testing methods and the quality assurance standards used. To obtain useful and timely data for decision-making, it is necessary to develop an efficient surveillance system with standardized protocols, strict quality assurance standards, clear information flow  and sustainable stewardship activities. Mitigating AMR has been identified as an area that requires strengthening in CARICOM Member States.

Toward a Solution

To address the issue, PAHO/WHO brokered a partnership between CARICOM and Argentina to leverage the latter’s best practices on antimicrobial resistance, which led to the development of the project Strengthening Antimicrobial Resistance Detection and Surveillance at the National and Regional Level in the CARICOM Member States. The project is strengthening capacity to conduct high-quality testing for the detection of AMR, collate and analyze AMR laboratory data and use the laboratory results to monitor trends, improve prescribing practices and AMR prevention activities. Technical expertise and solutions are being shared between Argentina and 14 independent CARICOM member states to guide public health interventions. The objectives include improving the capacity for diagnosis and characterization of AMR in clinical, veterinary and food laboratories, establishing national programmes for external quality assurance of AMR diagnosis, implementing a system of AMR data sharing in the Caribbean region and promoting and enhancing the use of AMR data for public health actions.

As a result of this exchange, nine Caribbean countries received support for the appropriate use of supplies and reagents provided to detect resistance mechanisms of clinical importance. To strengthen human resource capacity, personnel in 12 countries were enrolled in virtual training on laboratory capacity building for AMR detection and surveillance. The training included: (a) standards for internal quality control of susceptibility testing; (b) capacity-building to detect and differentiate among resistance mechanisms; (c) detection of emerging resistance mechanisms; (d) different approaches and techniques for identifying and susceptibility testing of Gram-positive cocci and some fastidious organisms; (e) knowledge on bloodstream infection diagnosis; and (f) remote support for the installation and use of WHONET software for AMR surveillance, data entry and data analysis.

Due to the COVID-19 pandemic, the adaptation of the workplan to virtual activities allowed greater interaction with many Caribbean laboratory technicians and a broader scope and audience, resulting in the participation of nearly 120 human and veterinary laboratory professionals interested in the diagnosis and surveillance of AMR. These virtual initiatives with a broader scope were well received, as AMR is not limited only to bacteria, but also is about training and laboratory capacity for the detection of AMR in fungal infections.

In line with the project strategy to promote horizontal partnerships by working in networks, the leading thematic network, ReLAVRA (la Red Latinoamericana de Vigilancia de la Resistencia a los Antimicrobianos) was expanded to integrate the Caribbean countries and renamed ReLAVRA+. Twelve laboratories in CARICOM member states are participating in an external quality assessment programme and eight received training after follow-up surveys that identified needed performance improvements. Ultimately, two countries in the Caribbean have been able to detect outbreaks of AMR bacteria in a timely manner.

The national authorities of the countries commit appropriate and sufficient human resources to this project to ensure that the expertise gained will be available beyond the duration of the project to maintain the AMR surveillance capacities acquired or strengthened. During the implementation period, sustainability plans will be developed to facilitate the smooth transition of activities from project to national and sub-regional programmes, taking into consideration that capacities have been built at national and sub-regional levels and that the work through existing networks will complement national capacity requirements.