Data Challenge - Pay Per Cure

Neisseria gonorrhoeae is considered a high priority pathogen for antimicrobial resistance (AMR). Multi-drug resistant gonorrhea has been reported worldwide but surveillance, especially in low- and middle-income countries is limited. The World Health Organization’s Global Antimicrobial Surveillance System recommends participating countries submit at least 100 isolates annually, and virtually no country meets this threshold. National treatment guidelines reflect this paucity of data, with Kenya guidelines including fluoroquinolones and amoxicillin/clavulanate among recommended first line agents and Malawi routinely using gentamycin in syndromic management. Sporadic reports of susceptibility indicate a potential for high-level resistance, but data are by no means nationally representative. In response to these concerns many countries are revising national action plans for AMR and their sexually transmitted infection treatment guidelines. The Clinton Health Access Initiative has been asked by the ministries of health of Kenya and Malawi, among others, to assist in this process. Without sufficient data, guideline revisions and treatment algorithms can only be opinion-based, and will be strongly influenced by financial considerations from already over-stretched budgets. We will use the available surveillance data for 3 purposes with major implications for patient outcomes and public health. 1) Even with the substantial data available through Vivli, surveillance is incomplete. An understanding of the available data and resistance trends for gonorrhea will help to inform more rigorous surveillance studies to fill gaps in the knowledge base. 2) A review of the available evidence will be used to construct data-informed antibiograms and for treatment guideline revisions that are currently in process. Those guidelines will include antimicrobial stewardship practices, such as optimal use of azithromycin in syndromic management. 3) An understanding of which drugs for gonorrhea are most likely to retain activity can be used in cost analyses that consider the need for laboratory diagnostics and the costs of failed empiric treatments.