Better infectious disease diagnostics is crucial to tackling antimicrobial resistance

Diagnostics can help us know if antimicrobials are needed and which specific antimicrobial might work best. Yet diagnostics are woefully underused and undervalued in the management of infectious disease, in all income settings. Without access to diagnostics, healthcare workers often rely on empirical prescribing of broad-spectrum antibiotics. This results in the inappropriate use of antibiotics, leading to the development of antimicrobial resistance (AMR). There are multiple reasons for this lack of prioritisation of diagnostics, including limited evidence of their cost-effectiveness both at the patient level and in the broader context of AMR and the lack of laboratory capacity in terms of workforce and infrastructure and resources.

In Latin America and the Caribbean, access to diagnostics for the identification of bacterial and fungal infection remains highly heterogeneous, as evidenced by the persistent inequity in the availability of automated and molecular methods at local and national levels. The Latin American and Caribbean Network for Antimicrobial Resistance Surveillance, ReLAVRA+, was created to strengthen laboratory capacity so reliable laboratory results could be used, first for clinical decision making and, after, for regional AMR surveillance. Building on more than three decades of coordinated laboratory collaboration, the network has generated robust evidence on priority AMR threats, including the widespread and evolving distribution of carbapenemases producing Gram negative bacteria.¹ The network has curated over eight million AMR data records, while also highlighting the persistent gaps in diagnostic capacity and molecular characterisation across countries.²

As diagnostics continue to evolve toward more complex, technology-intensive platforms such as MALDI-TOF Mass Spectrometry and automated identification and susceptibility platforms (with rising costs associated with instrumentation, reagents, consumables and service contracts) countries face growing challenges in sustaining access to quality-assured diagnostics at scale. In this context, the PAHO Strategic Fund provides a critical sustainability mechanism by enabling pooled procurement and quality assurance of essential diagnostic reagents and laboratory supplies, supporting countries’ transition from externally funded mechanisms to nationally embedded systems for AMR diagnosis and molecular characterisation within the ReLAVRA+ network.³

These successful approaches to regional capacity building and pooled procurement have informed the work of the DxAMR Collaborative. Established by the Fleming Initiative, the DxAMR Collaborative is an inclusive global partnership seeking to make diagnostics central to efforts to reduce AMR.⁴ Launched in Ghana in 2025, the Collaborative brings together individuals and organisations convinced by the potential improved diagnosis can have in reducing the AMR burden.⁵

In March 2026, the Collaborative held its second in-person meeting in Brasilia, as a side-event to the 1st Latam Regional AMR Summit. The aim was to build on the momentum from the inaugural gathering in Ghana and to ensure that the voice of the Latin America and Caribbean region, as a major regional contributor to AMR diagnostic innovation and implementation, was included in shaping the Collaborative's priorities.

The identified priorities include innovation, digital health & AI, access and market shaping, economics and policy, capacity and capability and quality and regulation. Each priority has a technical working group addressing these issues. The initial work programme of the technical working groups is set out briefly in Box 1.

Box 1. DX AMR Technical Working Groups Initial Work Programme.

Innovation, Digital Health & AI: Will focus on enhancing the utility of data from existing laboratory tests, identifying innovative tools that enable rapid pathogen identification and susceptibility testing, and advancing more affordable point-of-care diagnostics.

Access and market shaping: Has a launched a survey in Ghana to gain a clear understanding of regional challenges in accessing diagnostics. This work will feed into the group's strategy as to how to overcome these barriers and improve access. There is potential to replicate this elsewhere, with the Caribbean possibly next.

Economics and policy: Will strengthen the economic case for investment in diagnostics with an initial focus on their impact on older adults, including in Brazil. The group will also develop metrics to operationalise valuation frameworks, such as STRIDES.⁶

Country readiness and capacity: Will set out to gain a baseline understanding of existing capacity for local manufacturing of diagnostics in low and middle income countries. The group will also work with countries that received support from the Fleming Fund to identify best practice examples in how diagnostics should be implemented and sustained.

Quality and regulation: Aiming to create a manual to assist countries in establishing and operating local manufacturing of media and quality diagnostics. This could help strengthen regional supply, improve affordability, and increase access to essential diagnostic products. Additionally, they are looking to collaborate with various institutions to develop training for regulators.

It is important that DxAMR fits with broader work on diagnostics. For that reason, the Collaborative is aligned with the WHO Diagnostics Coalition, a WHO-managed informal network to support the more effective use of all diagnostics, not just those related to infectious disease.⁷

As well as working with multinational organisations, DxAMR will seek to work with national governments. Brazil was already thinking about the role diagnostics could play in tackling AMR, with a section on them in the second Brazilian National Action Plan,⁸ and is working to leverage the production capacity of the Unified Health System and strategies such as the Global Coalition for Local and Regional Production Innovation and Equitable Access⁹ to expand access to diagnostics. The DxAMR collaborative will seek to help all countries recognise the importance of diagnostics in tackling AMR and have it as a key aspect of funded national action plans.

Contributors

AA, MG, BG, and PH–Conceptualisation, writing–original drafting, writing–review and editing. APA and GA–Conceptualisation, writing–review and editing.

Declaration of interests

None.