Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment

Introduction: Antimicrobial resistance (AMR) is a global public health threat. Worse still, there is a paucity of data from low- and middle-income countries to inform rational antibiotic use. Objective: Assess the feasibility of setting up microbiology capacity for AMR testing and estimate the cost...

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Autores principales:	Grace Umutesi, Lotta Velin, Moses Muwanguzi, Kara Faktor, Carol Mugabo, Gilbert Rukundo, Aniceth Rucogoza, Marthe Yankurije, Christian Mazimpaka, Jean de Dieu Gatete, Cyprien Shyirambere, Bethany Hedt-Gauthier, Robert Riviello, Tharcisse Mpunga, Emil Ivan Mwikarago, Fredrick Kateera
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2021
Materias:	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/c3b3b57b687447238a97f7c0192d289c
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spelling	oai:doaj.org-article:c3b3b57b687447238a97f7c0192d289c2021-12-02T19:13:58ZStrengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment2214-999610.5334/aogh.3416https://doaj.org/article/c3b3b57b687447238a97f7c0192d289c2021-08-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/3416https://doaj.org/toc/2214-9996Introduction: Antimicrobial resistance (AMR) is a global public health threat. Worse still, there is a paucity of data from low- and middle-income countries to inform rational antibiotic use. Objective: Assess the feasibility of setting up microbiology capacity for AMR testing and estimate the cost of setting up microbiology testing capacity at rural district hospitals in Rwanda. Methods: Laboratory needs assessments were conducted, and based on identified equipment gaps, appropriate requisitions were processed. Laboratory technicians were trained on microbiology testing processes and open wound samples were collected and cultured at the district hospital (DH) laboratories before being transported to the National Reference Laboratory (NRL) for bacterial identification and antibiotic susceptibility testing. Quality control (QC) assessments were performed at the DHs and NRL. We then estimated the cost of three scenarios for implementing a decentralized microbiology diagnostic testing system. Results: There was an eight-month delay from the completion of the laboratory needs assessments to the initiation of sample collection due to the regional unavailability of appropriate supplies and equipment. When comparing study samples processed by study laboratory technicians and QC samples processed by other laboratory staff, there was 85.0% test result concordance for samples testing at the DHs and 90.0% concordance at the NRL. The cost for essential equipment and supplies for the three DHs was $245,871. The estimated costs for processing 600 samples ranged from $29,500 to $92,590. Conclusion: There are major gaps in equipment and supply availability needed to conduct basic microbiology assays at rural DHs. Despite these challenges, we demonstrated that it is feasible to establish microbiological testing capacity in Rwandan DHs. Building microbiological testing capacity is essential for improving clinical care, informing rational antibiotics use, and ultimately, contributing to the establishment of robust national antimicrobial stewardship programs in rural Rwanda and comparable settings.Grace UmutesiLotta VelinMoses MuwanguziKara FaktorCarol MugaboGilbert RukundoAniceth RucogozaMarthe YankurijeChristian MazimpakaJean de Dieu GateteCyprien ShyirambereBethany Hedt-GauthierRobert RivielloTharcisse MpungaEmil Ivan MwikaragoFredrick KateeraUbiquity PressarticleInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 87, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Grace Umutesi Lotta Velin Moses Muwanguzi Kara Faktor Carol Mugabo Gilbert Rukundo Aniceth Rucogoza Marthe Yankurije Christian Mazimpaka Jean de Dieu Gatete Cyprien Shyirambere Bethany Hedt-Gauthier Robert Riviello Tharcisse Mpunga Emil Ivan Mwikarago Fredrick Kateera Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment
description	Introduction: Antimicrobial resistance (AMR) is a global public health threat. Worse still, there is a paucity of data from low- and middle-income countries to inform rational antibiotic use. Objective: Assess the feasibility of setting up microbiology capacity for AMR testing and estimate the cost of setting up microbiology testing capacity at rural district hospitals in Rwanda. Methods: Laboratory needs assessments were conducted, and based on identified equipment gaps, appropriate requisitions were processed. Laboratory technicians were trained on microbiology testing processes and open wound samples were collected and cultured at the district hospital (DH) laboratories before being transported to the National Reference Laboratory (NRL) for bacterial identification and antibiotic susceptibility testing. Quality control (QC) assessments were performed at the DHs and NRL. We then estimated the cost of three scenarios for implementing a decentralized microbiology diagnostic testing system. Results: There was an eight-month delay from the completion of the laboratory needs assessments to the initiation of sample collection due to the regional unavailability of appropriate supplies and equipment. When comparing study samples processed by study laboratory technicians and QC samples processed by other laboratory staff, there was 85.0% test result concordance for samples testing at the DHs and 90.0% concordance at the NRL. The cost for essential equipment and supplies for the three DHs was $245,871. The estimated costs for processing 600 samples ranged from $29,500 to $92,590. Conclusion: There are major gaps in equipment and supply availability needed to conduct basic microbiology assays at rural DHs. Despite these challenges, we demonstrated that it is feasible to establish microbiological testing capacity in Rwandan DHs. Building microbiological testing capacity is essential for improving clinical care, informing rational antibiotics use, and ultimately, contributing to the establishment of robust national antimicrobial stewardship programs in rural Rwanda and comparable settings.
format	article
author	Grace Umutesi Lotta Velin Moses Muwanguzi Kara Faktor Carol Mugabo Gilbert Rukundo Aniceth Rucogoza Marthe Yankurije Christian Mazimpaka Jean de Dieu Gatete Cyprien Shyirambere Bethany Hedt-Gauthier Robert Riviello Tharcisse Mpunga Emil Ivan Mwikarago Fredrick Kateera
author_facet	Grace Umutesi Lotta Velin Moses Muwanguzi Kara Faktor Carol Mugabo Gilbert Rukundo Aniceth Rucogoza Marthe Yankurije Christian Mazimpaka Jean de Dieu Gatete Cyprien Shyirambere Bethany Hedt-Gauthier Robert Riviello Tharcisse Mpunga Emil Ivan Mwikarago Fredrick Kateera
author_sort	Grace Umutesi
title	Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment
title_short	Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment
title_full	Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment
title_fullStr	Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment
title_full_unstemmed	Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment
title_sort	strengthening antimicrobial resistance diagnostic capacity in rural rwanda: a feasibility assessment
publisher	Ubiquity Press
publishDate	2021
url	https://doaj.org/article/c3b3b57b687447238a97f7c0192d289c
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Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment

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