NiCaDe – AMR

Challenges addressed by the project

The project aims to support the Nigeria Centre for Disease Control and Prevention (NCDC) in capacity development for infection prevention and control.

Objectives

NiCaDe – AMR aims to support the national implementation of antimicrobial resistance (AMR) surveillance and a strategy for improving diagnostic stewardship. A focus will be placed on secondary healthcare facilities. Planned activities include providing technical support for the procurement of laboratory equipment and materials, capacity building for laboratories, diagnostic stewardship, data management and analysis and use of data for patient management, and infection prevention and control.

Overview of activities

In February 2019, Robert Koch Institute (RKI) supported the facilitation of an NCDC practical workshop on antimicrobial susceptibility testing (AST) and the use of WHONET in collaboration with the World Health Organization and the South African National Institute for Communicable Diseases.

In the spring of 2019, experts from NCDC and RKI engaged in a technical exchange meeting to finalise the national AMR surveillance guidelines and the harmonisation of standard operating procedures (SOPs) for diagnostic bacteriology.

Following this work, a concept for ongoing laboratory mentorship was discussed to encourage sustainable quality improvement along the microbiological diagnostic pathway. Twenty-five facilities in the Abuja Municipal in the Federal Capital Territory and in Lagos State were strategically selected in close cooperation with regional state health authorities in the spring of 2019. They were evaluated using a standardised online and onsite laboratory assessment checklist. Two model facilities in the Federal Capital Territory (Maitama District and Bwari General Hospitals) were selected. A microbiologist consultant conducted laboratory mentorship visits to these two selected facilities in June and August 2019. Critical gaps and next steps were discussed to standardise practices further and improve quality.

In early 2020, NCDC and RKI conducted an introductory workshop on diagnostic stewardship at the model hospitals. The team then proceeded to finalise a study protocol to evaluate a diagnostic stewardship intervention in selected hospitals, and this was approved by the local ethics committee in the spring of 2020. Due to the COVID-19 pandemic and the engagement of the project experts at NCDC and RKI in the response, some activities were delayed and shifted to virtual communication tools. Despite these challenges, NCDC continued to work to engage with the hospital study sites to prepare for the diagnostic stewardship study.

In August 2020, NCDC and RKI organised virtual and physical training workshops on the best practices of study data collection. In September 2020, the study commenced with the pre-intervention data collection in two facilities.

In 2021, improved laboratory equipment and materials were procured, and a comprehensive study intervention training was conducted on diagnostic stewardship pre-analytic/analytic/post-analytic procedures for laboratory personnel and clinicians at the model facilities. To support microbiology laboratory mentorship and sustainability, the bacteriology lead laboratory scientist from the National Reference Laboratory in Nigeria visited RKI, two National Reference Laboratories for AMR and routine diagnostic laboratories in Germany.

In February 2022, the RKI supported the NCDC in coordinating diagnostic and antimicrobial stewardship teams (DAMS) formation at the model sites. This was followed by a 3-stage capacity building training on the implementation of diagnostic stewardship and establishment of antimicrobial stewardship for the DAMS teams.

In May 2022, the NiCaDe AMR baseline study manuscript was published in the Antimicrobial Resistance & Infection Control (ARIC) research journal. A local medical microbiological expert developed a laboratory mentorship strategy with NCDC-NRL to support microbiology laboratories. To strengthen laboratory capacity and enhance the implementation of the laboratory mentorship programme, some laboratory equipment and consumables were procured and distributed to the model sites’ laboratories. The local medical microbiologist deployed the mentorship strategy with support from the NRL team during the bench-side mentorship programme piloted between May and July 2022 at Maitama District Hospital to review the laboratory processes for Antimicrobial Susceptibility Testing (AST), identify best practices, gaps and make recommendations.

In June 2022, the NCDC hosted Dr John Stelling, the WHONET developer, to train the DAMS teams on data management using the new WHONET 2022 features and to discuss strategies for supporting the National AMR surveillance system on WHONET.
In August 2022, two microbiology experts from Germany visited the model laboratories and the National Reference Laboratory for AMR in Nigeria to evaluate the impact of the diagnostic stewardship programme. In September 2022, the NCDC conducted a diagnostic stewardship and antimicrobial use PPS data collection training for the DAMS teams in Maitama District and Bwari General Hospitals to help the process generate reliable data to evaluate the impact of the interventions. In early October 2022, NCDC colleagues joined the team at RKI to conduct a review of the diagnostic stewardship interventions. In late October 2022, a post-intervention data collection refresher training was conducted for the DAMS teams and data collectors to facilitate the commencement of the data collection in the two facilities. In November 2022, the post-intervention data collection started in the two facilities.

To ensure the availability for the resources that were developed during the project, online learning materials are finalised and will be accessible soon.

Ongoing priorities focus on learned lessons from the study that are documented in a toolkit to promote improved diagnostic stewardship. Further support will be given to analysing AMR data for local and national use.

Last update: December 2022