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NIHR168786
£807,234
Feb 2026 – Jan 2029
Plain English Summary
Research Question: Can an integrated Digital AMR data capture, processing and sharing platform at National scale improve AMR detection and monitoring for enhanced AMR surveillance health outcomes in Uganda?
Antimicrobial resistance (AMR) is an urgent global public health threat that complicates treatment of infectious diseases. It is responsible for an estimated 1.3 million deaths worldwide each year. The burden is disproportionately high in low- and medium-income countries (LMICs) including Uganda, where AMR-associated mortality surpassed deaths due to malaria, HIV, and tuberculosis in 2019.
The NIAMR project proposes to develop and evaluate a national interoperable integrated digital AMR data capture, processing and sharing platform at national level, bringing together human health AMR data from multiple existing systems to support timely AMR detection, monitoring and evidence-based decision-making for improved surveillance and response in Uganda.
Background & Context
Antimicrobial resistance (AMR) is a global threat with significant health and economic consequences — increased mortality, prolonged hospital stays, rising healthcare costs, and diminishing treatment options. The United Nations General Assembly and the World Health Organisation (WHO) have identified AMR as a critical global public health threat.
In sub-Saharan Africa, AMR poses a particularly severe threat due to the high burden of infectious diseases compounded by inadequate healthcare resources (Murray et al., 2022). The drivers of AMR span community settings, animal and human healthcare, and the environment — including climate change, irrational use of antimicrobial drugs, non-adherence to treatment guidelines, and systemic health system weaknesses.
Several care and research groups across Uganda collect data on AMR. However, these data are mostly disjointed and fragmented across multiple systems. Key challenges include shortage of skilled personnel at facility and national levels, disjointed data systems, and limited clarity regarding national AMR data needs. As highlighted at the UN General Assembly High-Level Meeting on AMR, the Africa CDC Landmark Report, and the Uganda NAP (2024–2029), AMR data in many LMICs including Uganda remain fragmented, incomplete, and underutilised for decision-making despite investments in microbiology laboratory capacity.
Key Challenges
- Disjointed data systems across multiple unconnected platforms
- Limited interoperability between existing AMR data sources
- Underutilisation of collected data for surveillance and policy
- Shortage of skilled personnel for AMR data management
- Limited clarity on national AMR data requirements
Project Aim
Design & Methodology
This retrospective, three-year project will be implemented in five sequential phases. The project combines situational analysis, digital platform development, pilot implementation, impact evaluation, system optimisation, and cost analysis.
The platform incorporates artificial intelligence (AI) capabilities to support AMR detection, monitoring, trend prediction, and evidence-based decision-making. The project applies established technology adoption theoretical frameworks to evaluate feasibility and acceptance, including assessment of infrastructure needs, data protection requirements, and user-friendliness.
Community engagement and involvement (CEI) is embedded throughout all project phases. Stakeholder engagement ensures the platform meets actual data capture, processing, and sharing needs.
Project Phases
The project is implemented across five sequential phases (February 2026 – January 2029), from situation analysis through to national scaling.
Phase 1 — Situation Analysis & Baseline Assessment
Status: In Progress. National situation analysis and baseline assessment of AMR data generation, management, and dissemination in Uganda, using desk reviews and community engagement and involvement (CEI). Key output: National AMR data management situation analysis report.
Phase 2 — Platform Development & Pilot
Status: Upcoming. Development and pilot implementation of the integrated NIAMR platform in selected districts identified as AMR high-burden (red zones) via heat maps, to assess feasibility, acceptability and ethical considerations. Key output: Functional NIAMR platform deployed in pilot districts.
Phase 3 — Impact Evaluation at Scale
Status: Upcoming. Evaluation of the NIAMR platform's impact at scale on AMR surveillance performance and data use. Key output: Impact evaluation report on platform effectiveness.
Phase 4 — System Optimisation
Status: Upcoming. Assessment of system performance, data quality, and user uptake to inform optimisation and preparation for national roll-out. Key output: System optimisation report and national roll-out recommendations.
Phase 5 — Costing & Scaling Roadmap
Status: Upcoming. Estimation of costs for scaling the NIAMR platform nationally using a micro-costing approach, with a roadmap for integration across all One Health sectors. Key output: Costing report and national scaling implementation roadmap.
One Health Approach
Human Health
Overuse and misuse of antibiotics in clinical settings
Animal Health
Antimicrobial use in livestock for treatment, prevention, and growth promotion
Water & Environment
Antimicrobial residues and resistant bacteria entering waterways and soil
Wildlife
Wild animals serving as reservoirs for resistant organisms
The NIAMR platform is built with a scalable architecture extending beyond human health AMR data. While Phases 1–4 focus on human health data integration, Phase 5 specifically estimates costs and develops the roadmap for extending to animal health, water, wildlife, and environmental AMR data — aligned with Uganda’s NAP on AMR (2024–2029) and the WHO Global Action Plan.
Outputs & Outcomes
Key Outputs
- An interoperable and integrated digital AMR data capture, processing and sharing platform (NIAMR) with AI-powered detection capabilities
- A national AMR data management situation analysis report for Uganda
- Clearly defined national AMR data needs
- Clarified and documented AMR data governance structures
- NIAMR user and training guides
Expected Outcomes
Enhanced availability and use of integrated AMR data to support timely, evidence-based decision-making for AMR surveillance and response across Uganda.
Impact
Reduced AMR burden across human, animal, and environmental health in Uganda, with a scalable model for other countries and One Health sectors.
Dissemination
| Channel | Audience |
|---|---|
| Policy briefs | Policy makers |
| Academic journals | Researchers |
| Social media & formal media | General public |
| MoH & One Health sector websites | Health sector stakeholders |
| Workshops | Practitioners and implementers |
| National AMR Conference | CEI stakeholders |
Ethics & Governance
All research activities are conducted in accordance with national and international ethical guidelines. Ethics approvals are being obtained from relevant institutions including Makerere University and the Uganda National Council for Science and Technology (UNCST).
A core output of the project is clearly defined AMR data governance structures covering data ownership, data access and sharing, data quality, privacy and confidentiality, and data security.
References
- Murray, C.J.L. et al. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, 399(10325), 629–655.
- World Health Organisation (2015). Global Action Plan on Antimicrobial Resistance. Geneva: WHO.
- Ministry of Health, Uganda (2018). Uganda National Action Plan on Antimicrobial Resistance 2018–2023. Kampala.
- Ministry of Health, Uganda (2024). Uganda National Action Plan on Antimicrobial Resistance 2024–2029. Kampala.
- Africa CDC (2022). Antimicrobial Resistance: A Landmark Report. Addis Ababa: Africa CDC.
- United Nations General Assembly (2024). High-Level Meeting on Antimicrobial Resistance. New York.
