^{By Tatenda Chimbwanda}

Harare, Zimbabwe - From June 19-21, 2023, a team from World Health Organization (WHO) Head Quarters with support from US Centers for Disease Control and Prevention (US CDC), namely, Dr. Ismail Maatouk and Ms. Phiona Vumbugwa, Ms. Venessa Maseko; from Center for HIV and STI National Institute for Communicable Diseases  South Africa visited Zimbabwe to assess the implementation of the Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) and to conduct quality checks on laboratory procedures, clinical, and data management procedures.

Phase one of EGASP started in July and is planned to end in December 2023, with sentinel sites including Khami Clinic and Cowdrey Park Clinic in Bulawayo, Dulibadzimu Clinic in Beitbridge, and Mbare Clinic and Kuwadzana Clinic in Harare.

The primary objective of the visit was to evaluate the implementation of EGASP in Zimbabwe using standard protocol and standard operating procedures (SOPs). This involved conducting a thorough assessment of the laboratory procedures to identify areas that required additional training and laboratory support. Similarly, the clinical and data management procedures were carefully examined to determine any gaps that needed to be addressed through training and further epidemiological support. Additionally, discussions were held to outline the next steps necessary for strengthening and ensuring the long-term sustainability of EGASP in Zimbabwe.

During the visit, the team met with Ministry of Health and Child Care (MoHCC) officials, including Permanent Secretary Dr Jasper Chimedza and Director AIDS, sexually transmitted infections (STIs) and tuberculosis programs; Dr. Owen Mugurungi, to discuss the objectives and expectations of the visit. According to Dr Mugurungi “the importance of the antimicrobial resistance (AMR) surveillance, specifically STIs, is key in informing the review of STI guidelines and trends in Neisseria gonorrhoeae resistance in the country and region.”

Dr. Mugurungi made several recommendations, including a review of sentinel sites based on the budget and volume of clients, a feasible process for sample transportation, and staffing management.

Zimbabwe has implemented two rounds of Gonococcal Antimicrobial Surveillance Programme (GASP), in 2015 and 2019. The country uses syndromic treatment with Ceftriaxone 250mg intramuscularly as the first line treatment for gonorrhea. With EGASP, Zimbabwe aims to enhance the capacity and early detection of antimicrobial resistance (AMR), address GASP limitations, monitor trends of Neisseria gonorrhoeae using standardized protocols, and build capacity for AMR surveillance from laboratory facilities and sentinel clinics.

Dr Teodora Wi, STIs team lead in the department of Global HIV, Hepatitis, and STIs Programmes in WHO HQ, highlighted how EGASP strengthens the capacity for improving the epidemiology and surveillance of STIs and AMR, for the personnel of participating laboratories and clinics, and will allow an evidence-based update of the national STI guidelines for Neisseria gonorrhoeae.  

“EGASP is a great opportunity for Zimbabwe to monitor trends in antimicrobial susceptibility in Neisseria gonorrhoeae based on quality-assured laboratory testing. EGASP will allow the country to epidemiologically characterize men with  Neisseria gonorrhoeae not susceptible to recommended antimicrobial agents,” said  Dr Teodora Wi.

The team visiting Zimbabwe and the national officers also discussed the client flow, sample transportation, and data analysis and management. A recommendation was made to frame EGASP as a surveillance system and include sample collection as part of the treatment protocol.

In the laboratory aspect, recommendations were made to capacitate the Beitbridge District Hospital and Mpilo Reference Laboratory to culture in an incubator and isolates are preserved and capacitate local laboratory staff to ensure samples are sent on time.

This EGASP implementation visit was an important step in strengthening EGASP implementation and ensuring that STIs monitoring, and treatment protocols are accurate, comprehensive, and effective. With the detailed feedback and recommendations from the visiting team, Zimbabwe is better positioned to enhance its AMR surveillance and Neisseria gonorrhoeae treatment strategies. Efforts will continue to further improve the EGASP implementation process and to address the challenges identified during the visit.

EGASP aims to strengthen sentinel surveillance for gonococcal antimicrobial resistance (AMR) in selected countries. EGASP monitors trends in antimicrobial susceptibility in Neisseria gonorrhoeae  by using standardized sampling and laboratory protocols linked to epidemiological data in participating countries. The EGASP program in Zimbabwe and other countries globally is funded by the US CDC GARLRN – Global AMR laboratory and Response Networks. Zimbabwe among other countries in Africa such as Malawi, and Cote d’ Ivoire are countries earmarked to implement EGASP by September 2023.