Assessment of the Prioritization of Diagnostics in National Action Plans for Antimicrobial Resistance

BACKGROUND: Clinically diagnosing antimicrobial resistance (AMR) remains a challenge, with significant variation in countries' readiness and ability to address it. This study explores how diagnostic capabilities feature in national action plans (NAPs) for AMR, to respond to and manage infections in human health. METHODS: A targeted analysis was conducted of available NAPs of World Health Organization member states. NAPs were analyzed using predefined search terms and an analytical framework for diagnostic modality, key diagnostic activities (laboratory capacity, external quality assessment, surveillance, antimicrobial stewardship, and research) and key performance indicators (KPIs) specific to diagnostics. RESULTS: Of the 142 NAPs analyzed, 136/142 (95.8%) included diagnostics, mostly in the context of surveillance (131/142 [92.3%]) and building laboratory capacity (113/142 [79.6%]). Culture-based diagnostics appeared in 124/142 (87.3%) NAPs, point-of-care (POC) diagnostics in 47/142 (33.1%), and laboratory-based molecular diagnostics in 47/142 (33.1%). POC diagnostics were included most frequently in high-income country (HIC) NAPs (24/44 [54.5%]), and NAPs of the European region (21/37 [56.8%]). Diagnostic-specific KPIs were found in 35/142 (24.6%) NAPs, and KPIs specific to POC diagnostics in 9/142 (6.3%). Diagnostic KPIs were included most frequently in NAPs of the African Region (15/36 [41.7%]) and low- and middle-income countries (13/42 [31.0%]). CONCLUSIONS: While diagnostics feature in most NAPs, POC diagnostics are underrepresented, particularly in low- and middle-income countries lacking diagnostic infrastructure and resources. The lack of KPIs, particularly in HICs, prevents effective evaluation. This study highlights the need for improved strategic planning to ensure NAP objectives are translated into real-world deliverable action to manage AMR.