Background

Antimicrobial stewardship (AMS) programmes are essential to combat the growing threat of antimicrobial resistance (AMR). However, these programmes are primarily concentrated in in-patient departments of central and referral hospitals in low- and middle-income countries. AMR is spreading rapidly, and AMS policies are still in their early stages in these countries. Key challenges include limited access to clinical bacteriology laboratories, especially in district hospitals (DH).

Objectives

The project aims to improve AMR control in Vietnam by extending AMS to underserved clinical activities in Vietnam, i.e. outpatient departments (OPD) and DH. Specific objectives include:

1. to reduce unnecessary antibiotics prescribed by clinicians for patients hospitalized in DH and patients visiting the OPD through a multi-faceted AMS program;
2. to improve knowledge and practices on antibiotic treatment of clinicians working in targeted facilities through intervention activities facilitating clinicians’ learning process;
3. to implement and compare two innovative solutions to fill the gap of clinical bacteriology in DH;
4. to increase the use of microbiology data in antibiotic prescribing by clinicians through improving laboratory diagnostic stewardship in the targeted hospitals.

Methods

The interventions encompass:

1. Comprehensive AMS program in which prescribing practices will be improved through a learning process of five stages in the provincial hospitals. It includes training by an infectious diseases expert for clinicians and pharmacists, tracking and providing feedback on antibiotic prescribing, evaluating and improving laboratory stewardship, point-prevalence survey (PPS) for OPD retrospective audit and feedback (RAF) for DH, and development of treatment guidelines.
2. Innovative clinical bacteriology solutions for DH without pre-existing bacteriology laboratory capacity. In one DH, the implementation of a small-scale, standalone microbiology laboratory developed by MSF, called Mini-Lab; in another DH, daily transport of samples to Phu Tho provincial hospital as well as electronic transfer of results back to the DH, in a hub-and-spoke fashion; a third DH serves as control and receives AMS intervention only.

We will monitor several indicators to evaluate the impact of these interventions through a before-after design. These indicators include the proportion and amount of antibiotics prescribed by Access, Watch, or Reserve classification, the proportion of antibiotics and lab tests that are prescribed appropriately, changes in clinicians’ knowledge, and a wide range of lab performance indicators.

Outputs to date

Baseline data has been collected. As of Oct 2023, the project was in the intervention setup phase.

Posters promoting the WHO AWaRe classification, which are distributed to local healthcare centres