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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: Umutesi, Grace, Velin, Lotta, Muwanguzi, Moses, Faktor, Kara, Mugabo, Carol, Rukundo, Gilbert, Rucogoza, Aniceth, Yankurije, Marthe, Mazimpaka, Christian, de Dieu Gatete, Jean, Shyirambere, Cyprien, Hedt-Gauthier, Bethany, Riviello, Robert, Mpunga, Tharcisse, Mwikarago, Emil Ivan, Kateera, Fredrick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Ubiquity Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344959/
https://www.ncbi.nlm.nih.gov/pubmed/34430228
http://dx.doi.org/10.5334/aogh.3416
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author Umutesi, Grace
Velin, Lotta
Muwanguzi, Moses
Faktor, Kara
Mugabo, Carol
Rukundo, Gilbert
Rucogoza, Aniceth
Yankurije, Marthe
Mazimpaka, Christian
de Dieu Gatete, Jean
Shyirambere, Cyprien
Hedt-Gauthier, Bethany
Riviello, Robert
Mpunga, Tharcisse
Mwikarago, Emil Ivan
Kateera, Fredrick
author_facet Umutesi, Grace
Velin, Lotta
Muwanguzi, Moses
Faktor, Kara
Mugabo, Carol
Rukundo, Gilbert
Rucogoza, Aniceth
Yankurije, Marthe
Mazimpaka, Christian
de Dieu Gatete, Jean
Shyirambere, Cyprien
Hedt-Gauthier, Bethany
Riviello, Robert
Mpunga, Tharcisse
Mwikarago, Emil Ivan
Kateera, Fredrick
author_sort Umutesi, Grace
collection PubMed
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.
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spelling pubmed-83449592021-08-23 Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment Umutesi, Grace Velin, Lotta Muwanguzi, Moses Faktor, Kara Mugabo, Carol Rukundo, Gilbert Rucogoza, Aniceth Yankurije, Marthe Mazimpaka, Christian de Dieu Gatete, Jean Shyirambere, Cyprien Hedt-Gauthier, Bethany Riviello, Robert Mpunga, Tharcisse Mwikarago, Emil Ivan Kateera, Fredrick Ann Glob Health Original Research 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. Ubiquity Press 2021-08-06 /pmc/articles/PMC8344959/ /pubmed/34430228 http://dx.doi.org/10.5334/aogh.3416 Text en Copyright: © 2021 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Research
Umutesi, Grace
Velin, Lotta
Muwanguzi, Moses
Faktor, Kara
Mugabo, Carol
Rukundo, Gilbert
Rucogoza, Aniceth
Yankurije, Marthe
Mazimpaka, Christian
de Dieu Gatete, Jean
Shyirambere, Cyprien
Hedt-Gauthier, Bethany
Riviello, Robert
Mpunga, Tharcisse
Mwikarago, Emil Ivan
Kateera, Fredrick
Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment
title 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_short Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment
title_sort strengthening antimicrobial resistance diagnostic capacity in rural rwanda: a feasibility assessment
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344959/
https://www.ncbi.nlm.nih.gov/pubmed/34430228
http://dx.doi.org/10.5334/aogh.3416
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