Effective Stakeholder Engagement for Collation, Analysis and Expansion of Antimicrobial Resistance (AMR) Data: A CAPTURA Experience.

BACKGROUND: An effective implementation of antimicrobial resistance (AMR) surveillance projects requires sustainable and multidisciplinary engagement with stakeholders from various backgrounds, interests and aims. The "Capturing Data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia" (CAPTURA) project, funded by the Fleming Fund, initially targeted 12 countries in South Asia (SA) and Southeast Asia (SEA) to "expand the volume of historical and current data on AMR and antimicrobial usage" and support local agencies through capacity building activities. METHODS: In this article, we focus on early stakeholder engagement activities and present overall statistics on AMR data collated from 72 laboratories across seven countries. This included 2.3 million records of antimicrobial susceptibility testing (AST) data, which were curated, analyzed, and shared back to the facilities for informed decision making. RESULTS: Approximately 98% of the data collated by CAPTURA originated from laboratories based in SA countries. Furthermore, country-wide data were analyzed to identify commonly reported pathogens in each country, followed by descriptions of AST practices and multidrug-resistant (MDR) pathogens. Overall, we found meager adherence to standard guidelines to perform and record AST results, and a significant number of MDR pathogens were reported. CONCLUSIONS: We conclude that close collaboration with the existing national mechanisms for identifying AMR data sources was crucial for the project's success. Although we show a vast retrospective dataset on AMR is available for data sharing in Asia, there remain critical gaps in data generation/management practice and analysis capacity for AMR data at most facilities.

Methodological Approach to Identify and Expand the Volume of Antimicrobial Resistance (AMR) Data in the Human Health Sector in Low- and Middle-Income Countries in Asia: Implications for Local and Regional AMR Surveillance Systems Strengthening.

Antimicrobial resistance (AMR) is a multifaceted global health problem disproportionately affecting low- and middle-income countries (LMICs). The Capturing data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project was tasked to expand the volume of AMR and antimicrobial use data in Asia. The CAPTURA project used 2 data-collection streams: facility data and project metadata. Project metadata constituted information collected to map out data sources and assess data quality, while facility data referred to the retrospective data collected from healthcare facilities. A down-selection process, labelled "the funnel approach" by the project, was adopted to use the project metadata in prioritizing and selecting laboratories for retrospective AMR data collection. Moreover, the metadata served as a guide for understanding the AMR data once they were collected. The findings from CAPTURA's metadata add to the current discourse on the limitation of AMR data in LMICs. There is generally a low volume of AMR data generated as there is a lack of microbiology laboratories with sufficient antimicrobial susceptibility testing capacity. Many laboratories in Asia are still capturing data on paper, resulting in scattered or unused data not readily accessible or shareable for analyses. There is also a lack of clinical and epidemiological data captured, impeding interpretation and in-depth understanding of the AMR data. CAPTURA's experience in Asia suggests that there is a wide spectrum of capacity and capability of microbiology laboratories within a country and region. As local AMR surveillance is a crucial instrument to inform context-specific measures to combat AMR, it is important to understand and assess current capacity-building needs while implementing activities to enhance surveillance systems.

Utility and Evaluation of Applied Project Management Processes Within a Large Multicountry Health Systems Development Project Conducted During the Coronavirus Disease 2019 (COVID-19) Pandemic.

The increasing trends in antimicrobial resistance (AMR) continue to pose a significant threat to human health, with grave consequences in low- and middle-income countries. In collaboration with local governments and microbiology laboratories in South Asian and Southeast Asian countries, the Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project worked to identify gaps and expand the volume of existing AMR data to inform decision-makers on how to best strengthen their national AMR surveillance capacity. This article describes overall project management processes and the strategies implemented to address the disruptive impact of the coronavirus disease 2019 (COVID-19) pandemic on the project activities across diverse contexts in different countries. Also, it assesses in-country team's feedback on the conduct of activities and their overall impact on project completion. The strategies employed were tailored to the specific context of each country and included increased communication and collaboration among consortium partners and in-country teams, as well as hiring of additional in-country team members. This paper highlights the importance of local representation and capacities as well as real-time (virtual) engagement with stakeholders, ensuring close monitoring of the local situation and ability to tailor context-specific mitigation strategies to continue project implementation during disruptive external circumstances.

Considerations for Expanding Antimicrobial Resistance Surveillance Networks.

Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) gained insight into the range of national antimicrobial resistance (AMR) stakeholders' long-term visions for AMR surveillance networks. As national AMR networks mature, stakeholders often contemplate adding laboratories to the network to achieve greater representativeness, boost data quantity, or meet other goals. Therefore, stakeholders should carefully select laboratories for expansion based on their goals and several practical criteria. Based on CAPTURA experience, the key criteria a national network may consider when expanding its AMR surveillance network include location, laboratory ownership, access to linked clinical and prescription databases, logistical ease, a laboratory's collaborative spirit, laboratory practices and equipment, laboratory staffing and quality assessments, laboratory methods and specimen types, data cleanliness and completeness, and the quantity of AMR data.

Antimicrobial Resistance Surveillance Methods in Bangladesh: Present and Way Forward.

The Institute of Epidemiology, Disease Control and Research (IEDCR) conducts active, case-based national antimicrobial resistance (AMR) surveillance in Bangladesh. The Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project accessed aggregated retrospective data from non-IEDCR study sites and 9 IEDCR sites to understand the pattern and extent of AMR and to use analyzed data to guide ongoing and future national AMR surveillance in both public and private laboratories. Record-keeping practices, data completeness, quality control, and antimicrobial susceptibility test practices were investigated in all laboratories participating in case-based IEDCR surveillance and laboratory-based CAPTURA sites. All 9 IEDCR laboratories recorded detailed case-based data (n = 16 816) in electronic format for a priority subset of processed laboratory samples. In contrast, most CAPTURA sites (n = 18/33 [54.5%]) used handwritten registers to store data. The CAPTURA sites were characterized by fewer recorded variables (such as patient demographics, clinical history, and laboratory findings) with 1 020 197 individual data, less integration of patient records with the laboratory information system, and nonuniform practice of data recording; however, data were collected from all available clinical samples. The analyses conducted on AMR data collected by IEDCR and CAPTURA in Bangladesh provide current data collection status and highlight opportunities to improve ongoing data collection to strengthen current AMR surveillance system initiatives. We recommend a tailored approach to conduct AMR surveillance in high-burden, resource-limited settings.

Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA).

BACKGROUND: In 2015, the UK government established the Fleming Fund with the aim to address critical gaps in surveillance of antimicrobial resistance (AMR) in low- and middle-income countries in Asia and Africa. Among a large portfolio of grants, the Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project was awarded with the specific objective of expanding the volume of historical data on AMR, consumption (AMC), and use (AMU) in the human healthcare sector across 12 countries in South and Southeast Asia. METHODS: Starting in early 2019, the CAPTURA consortium began working with local governments and >100 relevant data-holding facilities across the region to identify, assess for quality, prioritize, and subsequently retrieve data on AMR, AMC, and AMU. Relevant and shared data were collated and analyzed to provide local overviews for national stakeholders as well as regional context, wherever possible. RESULTS: From the vast information resource generated on current surveillance capacity and data availability, the project has highlighted gaps and areas for quality improvement and supported comprehensive capacity-building activities to optimize local data-collection and -management practices. CONCLUSIONS: The project has paved the way for expansion of surveillance networks to include both the academic and private sector in several countries and has actively engaged in discussions to promote data sharing at the local, national, and regional levels. This paper describes the overarching approach to, and emerging lessons from, the CAPTURA project, and how it contributes to other ongoing efforts to strengthen national AMR surveillance in the region and globally.

La calidad de servicios maternos en un ambiente de mercado: Medellín, Colombia 2008-2009 / Compromised quality of maternal healthcare in a market economy: Medellín, Colombia 2008-2009

Objetivo: Analizar la calidad de los servicios maternos en la ciudad de Medellín, Colombia, en el Sistema General deSeguridad Social en Salud, desde la perspectiva de la madres usuarias de los servicios maternos y del personal involucradodirectamente en la prestación de estos.Metodología: Se llevó a cabo un estudio con enfoque cualitativo; se realizaron 24 entrevistas individuales a médicos yenfermeras que prestan servicios maternos y se llevaron a cabo tres grupos focales con maternas embarazadas o en períodode posparto. El análisis de la información se realizó mediante un proceso sistemático de codificación y categorización.Hallazgos: A pesar de las políticas internacionales, nacionales y municipales puestas en marcha para mejorar la atenciónmaterna y perinatal, las madres enfrentan constantes problemas de acceso y calidad en los servicios. Son aspectos que afectannegativamente la calidad de la atención los mecanismos de contención de los costos de personal que aplican las diferentesinstituciones, las barreras administrativas, las bajas tarifas por los servicios obstétricos que pagan las aseguradoras en unmercado competitivo y la búsqueda de rentabilidad financiera.

Atención materna en un ambiente de mercado de servicios de salud, Medellín, Colombia, 2008-2009 / Atendimento maternal em um ambiente de mercado de serviços de saúde, Medellín, Colômbia 2008-2009 / Maternity care within a health market environment, Medellin, Colombia 2008-2009

Objetivo: analizar el acceso a los servicios para maternas en Medellín, en el contexto del Sistema General de Seguridad Social en Salud. Metodología: se optó por un estudio cualitativo, se realizaron 23 entrevistas en profundidad a médicos y enfermeras, vinculados directamente a la atención materna y/o a la toma de decisiones gerenciales, y tres grupos focales con maternas. Las entrevistas se analizaron mediante el proceso de codificación y categorización propuesto en la Teoría Fundada. Hallazgos: a pesar de que la atención materno-infantil es una prioridad, las maternas experimentan dificultades con los servicios, dada la problemática del aseguramiento, la fragmentación de servicios en la contratación —ligada a la competencia por bajos precios—, y la posición dominante de las aseguradoras.

Objective: To analyze accessibility to maternity care services in the city of Medellin, within the context of the Colombian Social Security System for Health. Metho dology: A qualitative approach was used; 23 in-depth interviews were conducted to medical doctors and nurses who provide health care to mothers and/or manage health institutions. Also, three focus groups with mothers were carried out. A coding and categorizing process was used to analyze information following Grounded Theory process. Findings: In spite of the fact that maternal-child care is a priority issue, mothers experiment difficulties to access to health services, given by the insurance system, fragmentation of services in contracting out process between insurer and hospitals –linked with competence based on lower prices- and the dominant status of private health insurers.

Objetivo: analisar o acesso aos serviços para mães em Medellín, dentro do contexto do Sistema Geral de Seguridade Social em Saúde. Metodologia: optou-se por um estudo qualitativo, foram realizadas 23 entrevistas com médicos e enfermeiras, vinculados diretamente ao atendimento materno e/ou à tomada de decisões gerenciais, e três grupos focais com mães. As entrevistas foram analisadas mediante o processo de codificação e categorização proposto na Teoria Fundada. Descobrimentos: apesar de que o atendimento materno-infantil é uma prioridade, as mães experimentam dificuldades com os serviços, devido a problemática da afiliação, a fragmentação dos serviços – ocasionada pelo modelo de contratação que se baseia nos preços baixos, e a posição dominante das seguradoras.