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11 Mar 2024

The COMBAT-AMR Assessment Framework: a blueprint to addressing AMR

Antimicrobial resistance (AMR) significantly challenges global public health by undermining the effectiveness of infectious disease treatments. Although a number of tools exist to support policy and surveillance efforts against AMR, there is still a need for simple, comprehensive instruments that provide an in-depth analysis of AMR policies, practices and capacities, to inform response. The recently developed COMBAT-AMR Assessment Framework might remedy the current shortfall in cohesively assessing and managing AMR capabilities across human and animal health sectors and settings.

The COMBAT-AMR Project team reviewed existing tools, adapted and piloted them to enhance AMR surveillance capacity-building efforts. The result is the Assessment Framework, which includes five assessment tools that can be used individually or collectively to align with national AMR action plans.

Published in BMJ Global Health by Doherty Institute researchers, in collaboration with other universities and health research institutes, the Framework includes the Human Health Laboratory; Antimicrobial Stewardship; Animal Health Laboratory; Infection Prevention and Control and Water, Sanitation and Hygiene (IPC WASH) tools and the National AMR Situation Assessment tool.

University of Melbourne’s Dr Angeline Ferdinand, Research Officer in the Microbiological Diagnostic Unit Public Health Laboratory (MDU PHL) at the Doherty Institute and co-first author, said the Framework provides a systematic, cross-sectoral model for assessing AMR capacity, which is adaptable for various uses and supportive of national AMR strategies.

“The Framework's flexibility means it can be used to evaluate individual institutions or in the broader context of national policy alignment, by supporting priority setting, program design, monitoring and implementation,” she said.

“After completing the assessment tool, standardised summary reports, including a comprehensive analysis of strengths and opportunities, are generated. A scoring system is then used to inform discussions with stakeholders for recommendations and prioritisation of key intervention areas, feeding into the development of project workplans.

“Importantly, the Framework is not set in stone. We work with in-country stakeholders to continue to refine the instruments. I think this collaborative, ongoing improvement process is a real strength of the Framework,” she added.

Bacterial AMR directly caused approximately 1.27 million deaths worldwide in 2019 and contributed to nearly 4.95 million deaths. Key strategies to combat AMR in human health involve preventing infections, reducing antimicrobial misuse, ensuring everyone can access accurate diagnostics and correct infection treatment, and promoting strategic information and innovation. This comprehensive approach includes surveillance of AMR patterns and antimicrobial use, along with research into new vaccines, diagnostic tools and treatments.

University of Melbourne’s Professor Benjamin Howden, Director of MDU PHL at the Doherty Institute and senior author, said the Framework is designed to facilitate transparency in establishing AMR priorities for both human and animal health sectors at country and institutional levels.

“Ensuring that antimicrobials continue to be effective in preventing and treating infectious diseases is a global public health priority and requires strong policies and laboratory capacity,” he said.

“Our COMBAT-AMR Assessment Framework will inform investment and capacity-building to address antimicrobial resistance. This is particularly vital for low- and middle-income countries facing urgent challenges.”

The COMBAT-AMR Assessment Framework has been rolled out in several countries, demonstrating its role in enhancing AMR-related capacities. Users can complete the Framework independently or with assistance from the COMBAT-AMR technical team, facilitating collaborative development of strategies to strengthen AMR response efforts. The Framework is available for use more broadly, with details available here. 

Peer review:  Ferdinand A, et al. Development of a cross-sectoral antimicrobial resistance capability assessment framework. BMJ Global Health (2024). DOI: 10.1136/bmjgh-2023-013280

Funding: Australia’s Department of Foreign Affairs and Trade.

Collaborators: WHO Collaborating Centre for Antimicrobial Resistance (Doherty Institute), Burnet Institute, Alfred Health, Massey University, Pacific Regional Infectious Diseases Association (PRIDA), The Asia-Pacific Centre for Animal Health (APCAH), WaterAid.