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Data Driven Planning for AMR Laboratories

March 2018 | Gabon Meetings - AMR Laboratory Planning

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It is estimated that:

300 million people are expected to die prematurely because of drug resistance over the next 35 years
World's GDP will be 2 to 3.5% lower than it otherwise would be in 2050.
Will create significant and widespread human suffering.

Global AMR Challenge

By 2050, Global Mortality Will Look Like …

Deaths attributable to AMR every year by 2050. (Via the Review on Antimicrobial Resistance)

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AMR Lab Mapping Project Scope

We provide tools throughout the data life-cycle, that can easily adapt to any context

1: COLLECT

Problem: Data on what labs and facilities exist and what services they provide is missing.

Our Plan: When data doesn't exist, we provide tools to collect it.

3: USE & PLAN

Problem: Once the data exists, we want to use the data in impactful ways.

Our Plan: Use open source planning tools to find gaps / bottlenecks in coverage + visualize and share data with partners.

2: MANAGE

Problem: When the data exists, tool don’t always to easily store, curate and share it.

Our Plan: Support each country to set-up a lab registry to manage and share data.

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Our Team

Is made up of a growing group of laboratory, technology, design and local experts...

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Collect Lab Data

When data doesn’t exist, we work to help collect it

Use pre-configured, customizable and reusable digital forms via Ona.io that allow to collect data offline

Collect GPS coordinates and service data via onsite assessments

Integration with a facility registry, to transition to ongoing curation & use

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Where Are Labs for AMR Detection

ARM Surveillance Capacity is Early Stage, and Data is Limited

2018 Survey Results From ASLM Survey of Laboratories in Niger - 153 labs

ASLM Collects Data When it is Missing

GPS
Laboratory Level: e.g., District or BSL
Laboratory Tests: Bacterial Culture or Tuberculosis Resistance
Staff: Microbiologists
QA/QC: SLIPTA Score
Infrastructure: Water, Power

ASLM Sets up Registries if Needed…

Import data to a software tool
Manages, curates and shares data

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AMR Trainings for, where they will:

Test the most potential cases
Are closest to a current outbreak

Adding AMR Testing or Microbiology Equipment to Labs Where They Are Most Needed - e.g., incubator
Optimizing the Referral Networks to Reduce Travel Costs and Speed Up Testing Times

Selecting The Best Lab to Upgrade to a Reference Laboratory.

Largest population w/in acceptable travel time?
Closest to hotspots of AMR?

Better Designed Networks Yield Big Impact

Health officials can deliver significant results for AMR by...

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We Can Calculate True Catchment

IDENTIFYING THE TESTING NEED

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Define collection facilities

The analyst defines the test that is being analyzed and with that, the health facilities that are currently taking samples or that could (depending on the scenario being analyzed). These will be the locations where AMR testing is more needed for the service will be aggregated.

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Target population

Using demographic variables, the analyst filters the region population to identify the population segment that should have access to the test under analysis.

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Catchment areas

Planwise allows the analyst to define acceptable traveling times by car and foot to the sample collection facility. Those parameters will define the site catchment area. Planwise will indicate the reach and concentrate the AMR testing need in each facility.�

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Catchment & Lab Locations Allow Us To

USE DATA TO BEST GROW THE LAB NETWORK

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Select labs

The analyst filters the labs that can perform the test being analyzed and optionally defines the referrals from sites.

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Labs catchment area

The analyst defines acceptable sample travel times to the lab. Planwise shows the catchment area for the labs and calculates the satisfied where AMR samples are coming from.

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Unsatisfied AMR Testing Need

Planwise detects sites that are outside the catchment area of labs or that are in the catchment area of labs whose capacity is lower than the current need for AMR lab testing.

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Optimize Service / Lab Location

Planwise suggests options to upgrade the capacity of existing labs or add locations of a new services, and informs the level of additional need for testing that can be satisfied.

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Budget for AMR Lab Network Enhancements

What does it cost to upgrade an existing lab or to create a new one?

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Budget for Laboratory Network Enhancements

What will it cost to upgrade an existing lab or to create a new one?

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Configure Acceptable Travel Times

What is the longest walking or driving time that is acceptable for your patients?

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Review Configuration

You have completed the necessary configuration, make sure it looks right before proceeding

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Review Suggested Scenarios

Planwise then provides different options for how to best expand coverage

Each scenario has a specific set of actions or recommendations it

The actions can be created by the user defining costs and impact

Review the projected costs for each scenario

Niger AMR Lab Planning

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Review Suggested Scenarios

Visually review scenarios, and adjust location based on your own knowledge

Adjust locations based off local knowledge

Weigh the benefits of broader coverage vs. higher capacity

Share analysis with colleagues to review, build consensus, and execute on your plan

Niger AMR Lab Planning

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How To Get Involved?

The ASLM Team is Looking For…

Groups to help to collect lab data and run lab registries

Fundraising partners to scale the program to more locations
Partners that want to use lab, catchment, population coverage data in innovative and impactful ways

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Thank You!

Questions?

Contact: [PRESENTER NAME HERE]

ASLM: @ASLM; www.aslm.org

InSTEDD: @instedd; www.instedd.org

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Annex

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Common Challenges:

Data is missing, incomplete and out of date
Data is spread across systems / spreadsheets
Data is difficult to access
Simple tools to visualize & use data don’t exist
Projects, partners and programs start from scratch
Getting GPS data and using it is expensive and costly;
& often requires international consultants

Where Are Labs Located? What Services Do They Provide?

Without this basic data, interventions and their impact are severely limited

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Facility Registry Data Curation

After we initially collect the lab data, how do we keep it current?

Each day after data is collected it reduces in quality as sites -> open, close, move, and change

Creating a data use cycle, is critical...

Data that is used, is valued,
data that is valued, is kept current,
data that is current gets used.

Make a plan for how data will be kept current that is realistic. Frequency of data curation may include:

Routine data curation, where updates are made in the registry as they occur
Bulk updates on a schedule; where expectations on timeliness are clear

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Key Curation To Ask on Data Curation

To Begin this Discussion Collaboratively Review…

Who knows the answers regarding what lab services are available at each lab?

Lab Staff? Regional Managers? An NGO?

How can they easily share updates to the registry?

Through a website? Over email? Phone Interview? Paper?

How regularly should they provide these updates?

As they happen year round? Once a Month / Quarter / Year?

What can we do to make this process as simple as possible?

We update required fields monthly; Other fields each year
There is a web-form where lab staff can enter their own data
We do a simple phone interview and enter the data for them
We make sure labs have access to the data for their own purposes
We let the public report issues?
Do we really need to have all these fields?

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Patterns of Data Curation

To Begin this Discussion Collaboratively Review If…

Lab staff can enter data directly into a facility registry via the web

Pros: Accurate; Cons: Requires some support & follow-up; turnover is an issue

Lab staff suggest edits via the web, that are approved by supervisors, before it is updated in the registry

Pros: More Accurate; Cons: Requires Training, high turnover, approval bottlenecks

Regional staff make phone calls to review data and update it into the registry.

Pros: Accurate & Cheaper; Cons: Could be difficult to reach staff by phone

Enumerators go to the facility to collect data via a digital form

Pros: Super Accurate; Cons: Expensive, time consuming

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2: Manage Lab Data

A facility registry is a simple tool to manage, curate and use lab data

Lab Data Set: Are the key details associated with each laboratory location.

Registry Software: A software service that stores data, manages users, provides APIs, tracks changes, and supports other tools.

Governance and Curation: The human policies and process that support the data and service.

Use of Quality Data: Apps & Tools can use data from the registry for analysis, planning and sharing

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2: Manage Lab Data

A facility registry is a simple tool to manage, curate and use lab data

Key Functionality:

Define data specification
Manage user access
Bulk import / update
Robust APIs
Simple Exports
Search, Filter, Group
Activity Tracking
Create New Sites & Edit Existing Ones

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3: Lab Data Planning and Use

Why spend time collecting and managing this data? So we can use it in impactful ways…

Ways We Plan To Use Lab Data Include:

Create an African Registry of Laboratories

Use Planwise to identify gaps in AMR lab coverage and optimize lab services, capacity, surveillance and AMR interventions

Make data accessible to the eco-systems; for analysis, research and other innovation by the ASLM community.