A role for private sector laboratories in public health surveillance of antimicrobial resistance

Type: Article

The Question

Many high-income countries have surveillance systems that keep track of antimicrobial resistance (AMR) rates, but very few low- and middle-income countries (LMICs) do. Can networks of private laboratories help fill this data gap in LMICs?

What we found

In LMICs, several factors have led to a lack of AMR surveillance, from inadequate laboratory capacity to a simple lack of funding for such programs. In public health laboratories, many lab workers aren’t trained and can’t carry out tests for antimicrobial resistance. Facilities frequently lack functioning equipment, or have unreliable access to electricity, water, or necessary chemicals to carry out tests. In places where public labs have some testing capacity, there’s little to no standardization between locations.
 
In these countries, though, private healthcare and private labs are a quickly growing enterprise—and can solve some of the quality problems of public facilities. Majority of the labs accredited by national and international organizations in these countries belong to private sector. For example in India and South Africa >90% and >80% of the accredited labs belong to private sector, respectively. These accredited labs have better trained staff, greater capacity for quality testing and information systems to store and manage data.
 
CDDEP’s ResistanceMap is one of the first projects to collect AMR data from LMICs, gathering information on antibiotic resistance rates from private lab networks. For instance, in India, ResistanceMap utilizes data from a large private laboratory network with, approximately 5700 collection points including private hospitals and community diagnostic labs in 26 states, aggregating more than 18,000 blood isolates between 2008 and 2014. In South Africa, CDDEP has combined private lab data with public sector data to estimate the extent of antibiotic resistance using several sources, and compare resistance rates between public and private sectors.

Why it matters

The first step to containing antimicrobial resistance is knowing the extent of the problem: which strains of bacteria won’t respond to treatment with which antibiotics, and where. High-income countries can often establish government-sponsored programs with quality standards across geographic locations using trained staff. LMICs rarely have the infrastructure or finances for this—but as resistance rates continue to grow worldwide (including in LMICs), this data is direly needed to combat the problem. If private lab networks can help gather quality surveillance data, that’s a critical step in keeping antibiotics effective for the world.