Assessment of the prioritisation 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 WHO member states. NAPs were analysed using pre-defined 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 specific to diagnostics. Results Of the 142 NAPs analysed, 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 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 LMICs 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.