The CoEval-AMR network was created in 2019 with the goal of bringing people together to harmonize and refine existing methods and tools for assessing AMU and AMR surveillance from an integrated and systemic perspective.

Challenge       

The mitigation of antimicrobial resistance (AMR) is informed by fit-for-purpose, integrated surveillance systems that allow identifying emerging resistance, understanding the AMR epidemiology, and planning and evaluating policies for AMR reduction. International organisations have called for collaboration across animal, human and environmental sectors and adoption of a “One Health” approach. Several integrated surveillance strategies exist, but their performance and economic value remain to be evaluated.

Multiple research groups worldwide are working on the evaluation of integrated AMU/AMR surveillance looking at how approaches and methods can be refined to provide information that is relevant for making decisions on what surveillance approaches to use and thereby support the management of AMU and AMR. So far, the work of different research and implementation groups has resulted in multiple frameworks and disjointed recommendations for evaluation and measurement, which can be confusing for users.

Therefore, the aim of this Network was to bring people together with the aim to harmonise and refine existing frameworks and approaches for the evaluation of AMU and AMR surveillance taking an integrated perspective.

Objectives

• To promote knowledge exchange and peer-learning among people working on evaluation of

integrated surveillance for AMR

• To compare existing evaluation frameworks, approaches, methods & metrics for AMR surveillance
• To identify synergies, duplication, and gaps
• To select critical elements that should be part of a harmonised evaluation approach
• To create a harmonised evaluation framework
• To make available publicly protocols and written guidance for the harmonised evaluation framework

Solution      

The main aim of the network was to develop guidance for harmonised evaluation of integrated AMU and AMR surveillance from a One Health perspective that addressed the specific needs of such surveillance systems. Five working groups (WGs) were created and worked towards this goal in multiple workshops, missions, online meetings, and through individual work.  The main output was a publicly accessible online guidance (https://guidance.fp7-risksur.eu/) on the evaluation of integrated AMU and AMR surveillance. It contains a section on evaluation in general, an overview of existing tools in relation to a theory of change of AMU/AMR surveillance, decision support to identify a suitable evaluation tool based on the user's evaluation needs, and a section on user experiences when applying different tools. The online guidance is supported by a range of instructional videos so that users can learn about the evaluation of AMU/AMR surveillance in an easily accessible way. The evaluation guidance provides support to personnel working in public, private and non-governmental organisations working to protect the health of humans, animals, plants and the environment at local, national and international levels through AMU/AMR surveillance. It helps users to conduct evaluations of their AMU/AMR surveillance systems which will provide information on the functionality, effectiveness and efficiency of these systems and allow identifying potential areas for improvement.

Impact      

The application of the novel, harmonised guidance for evaluation of integrated AMU/AMR surveillance systems nationally and internationally in the mid-term would allow working towards a database/compilation of case studies that demonstrates what works and does not work in AMU/AMR surveillance. Consequently, such work will allow identifying areas for improvement and offer an opportunity for changes that may increase the effectiveness and efficiency of integrated AMR surveillance.

The knowledge produced in the long-term is expected to lead to improved health of populations by allowing the identification and prioritisation of effective and efficient integrated surveillance strategies for AMU/AMR. The need for better evidence on the value of One Health surveillance is crucial for its wider implementation.

The CoEval-AMR network has received funding from the Joint Programming Initiative for AMR (JPIAMR) to support a second phase of activities to address the gaps identified in the first phase. The second phase is led by Cécile Aenishaenslin from the University of Montreal.

Partners      

We thank the Joint Programming Initiative for AMR (JPIAMR) for funding this project.

Publications