Surveillance system for Antimicrobial Resistance with “One Health” approach in collaboration with ICMR and UiO

Addressing the scourge of Antimicrobial resistance (AMR) within the “one health” framework, is an urgent priority area identified by both international organizations and national governments. The 68th World Health Assembly has come up with a Global Action Plan to combat AMR (GAP-AMR), and a key objective is to “Strengthen the knowledge and evidence base through surveillance and research”. Member state actions identified under this objective concerns developing a national surveillance system that supports the systematic collection and analysis of data and strengthens surveillance in all AMR domains mainly Human, Animal and agriculture sectors.

The current system is developed on DHIS2 platform and caters to the requirements of human domain as a collaboration between University of Oslo, HISP India and Indian council of Medical research (ICMR) with the expertise from the AMR experts from Norway and India.

Given the extreme complexity of this task, the application is being developed in an incremental and step-wise manner, and a starting point was the development of prototypes for Human domain.

The system designed for human component allows longitudinal tracking of the patients using DHIS2 Tracker. Patients are registered in organism group specific programs and data is entered in program stages based on the sample type and the organisms isolated from the sample. Application has been designed to calculate results based on the values entered against Antibiotics in Disk Diffusion and MIC (AMR test types).

The results are classified between Susceptible, Intermediate and Resistant automatically. Based on this classification, colors (Green, Yellow and Red) are assigned to the data elements respectively for Susceptible, Intermediate and Resistant. Also, the application has the option to enter results for Phenotypic and Genotypic tests wherever the tests have been conducted.

For analysis, the data collected in program stage events is aggregated by pushing the required variables in aggregate data elements. This is done using an app which aggregates the event data and push the same to aggregate data elements daily.

The Dashboards have been designed for Isolation rates and resistance patterns based on organism groups, organism species, sample types, antibiotics etc.

The next steps include scaling up the system for other AMR domains including Veterinary (Food producing animals), Agriculture, designing system for molecular surveillance and a module on Antimicrobial consumption.

Workshops conducted

1) Workshop on Design and Development of Framework for Integrated Surveillance of Antimicrobial Resistance

Indian Council of Medical Research, Nov 12-13, 2018, jointly Organized by ICMR and University of Oslo, Norway.

This 2-day workshop was an Indo-Norwegian initiative to brainstorm and conceptualize way forward to design and develop a framework for an integrated AMR surveillance system, bringing together data from human, animal and environmental sources. The workshop brought in experts from various domains of AMR (Human, Animal and Environment) and digital health technologies. The experts brainstormed initial roadmap for the development of a One health network for the AMR surveillance.

2) AMR Surveillance workshop

University of Oslo, April 11 and 12, 2019

This was a 2-day workshop with experts from around the globe to explore integrations and collaborations between WHONET and DHIS2 and building terminology and accepting global standards in DHIS2.

Feedback on the system developed by HISP India in collaboration with UiO and ICMR on DHIS2 platform was collected for the system to be used globally.