EQAsia develops a free EQA ‘one-stop-shop’ to combat AMR


The Fleming Fund grantee Technical University of Denmark improves bacteriology diagnostics to combat antimicrobial resistance (AMR) through the provision of External Quality Assessments (EQAs) to National Reference Laboratories (NRLs) and centres of excellence in low and middle-income countries of the South and Southeast Asia regions.

An EQA is used to compare a laboratory’s testing methods to an external source, such as a peer group of laboratories or to a reference laboratories’ performance. For the EQAsia project, supported by the Fleming Fund, EQAs are carried out to ensure the quality of bacteriology diagnostics for antimicrobial susceptibility testing in Asia.

Under a One Health (OH) remit, EQAsia is providing a free of charge EQAs and training programmes to 40 laboratories from 14 countries to date: Bangladesh, Bhutan, Brunei, Indonesia, Lao PDR, Malaysia, Maldives, Nepal, Pakistan, PNG, Philippines, Sri Lanka, Timor-Leste, Vietnam.

Two of its most notable features are the design of diagnostic EQAs that focus on phenotypic species identification and antimicrobial susceptibility testing (AST) of WHO-GLASS and FAO priority pathogens, and the implementation of a unique online informatic ‘One-Shop EQA tool for reporting and analysis, EQA results. This simplifies data processing for EQA facilitators and enables the participants to assess new EQAs and review past performance.

Global harmonisation

Towards global harmonisation of standardised effective AMR data methods, EQAsia resembles online informatics tools for reporting EQAs and a One-Health design of EQAs European programmes (EURL, EARS-NET), and Fleming Fund grants SEQAFRICA and EQAFRICA.

Earlier this year, the Consortium partners met in person for the first time in Bangkok since the programme’s inception in October 2020. Here, the Scientific Advisory Board and Coordination Group were appointed consisting of leading EQA experts and trainers.

As well as DTU, the EQAsia Board includes two partners in Thailand, who are leading experts and trainers in the field of diagnostics and AST: the Faculty of Veterinary Science at Chulalongkorn University (CU-VET), and the National Institutes of Health (NIH).

These partners work in collaboration with the International Vaccine Institute (IVI) based in Seoul as principal trainers across Asia in laboratory practices and quality management systems (QMS), including developing costing and forecasting analysis.

EQAsia partners at the programme meeting in Bangkok earlier this year.

EQA laboratories

The meeting focused on learnings, achievements, and challenges of the programme activities of its ongoing Fleming Fund Phase I, including:

Presentation at the EQAsia programme meeting earlier this year.

Principal Scientist of EQAsia Patrícia Teixeira dos Santos at DTU, said in Phase I:

“32 of the 40 EQAsia-participating laboratories have completed at least one EQA round. Both the One-Shop EQA programme and the EQAs trials have been supported by training and workshops, as well as post-EQA consultation meetings to underperforming laboratories of each EQA round.”

Project Manager of EQAsia Paulina Tamez-Hidalgo at DTU, added:

“Even with challenges due to the heterogeneity capacity for AST of the participant laboratories, COVID restrictions, and language barriers, EQAsia is reaching its goals and consolidating the plan for improving, maintaining, and expanding in years to come.”

Sustainability and beyond

Furthermore, recommendations for actions needed to maintain, improve, and expand the programme for Fleming Fund Phase II were also set – agreeing on actions and other recommendations for maintaining, expanding, and securing further funding.

The EQAsia’s ‘exit strategy’ and sustainability plan are in progress to consolidate the stakeholder groups for Phase II and beyond. This includes a situation analysis; terms of reference; communication plan; costing surveillance system forecasting and sustaining activities; responsibility matrix, to consolidate the programme’s stakeholder management.

Grantee lead of EQAsia Rene S. Hendriksen at DTU, added:

“With the continuous goal of improving surveillance systems by enhancing the quality of AMR diagnostics in Asia, the specific aim is providing EQAs and training to NRLs and centers of excellence, with the long-term vision to elevate their capacity to provide EQAs in their own countries complying to the obligations and functions as NRLs.”

“Therefore, promoting the quality of AMR data on surveillance systems, leading to adequate policies for efficient use of antimicrobials on clinical patients and during veterinary interventions.”

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As a Veterinary Investigations Officer at the Ministry of Agriculture in Zimbabwe, Kudzaishe Vhoko-Tapesana joined the Fleming Fund fellowship scheme in May 2021. Hosted by the [London School of Hygiene and Tropical Medicine (LSHTM)](https://www.lshtm.ac.uk/), Kudzaishe’s Fellowship advances her professional development while supporting country efforts to improve surveillance of antimicrobial resistance (AMR) in animal health.