Form Approved |
OMB Control Number: 0920-1282 |
Expiration Date: 06/30/2026 |
Public reporting burden of this collection of information is estimated to average 4 hours per response per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1282).
FORM 1: RECIPIENT INFORMATION 2
SECTION 1: PROJECT IMPLEMENTATION 3
SECTION 2: LABORATORY CAPACITY SUPPORT 5
SECTION 3: SURVEILLANCE CAPACITY 7
SECTION 4: WORKFORCE DEVELOPMENT CAPACITY 9
FORM 2: PROJECT IMPLEMENTATION AND REFERRAL NETWORK/SURVEILLANCE ACTIVITIES 11
SECTION 1: PROJECT IMPLEMENTATION PHASE 12
SECTION 2: LABORATORY NETWORK ACTIVITIES 13
****Please complete the following forms based on project activities during the current budget period (BP3).
Form to be completed at recipient level. If any recipients are implementing projects across strategy areas, they will be asked to complete Sections 1-3 for each strategy.
Name of Recipient Organization:
Recipient HQ location:
GARLRN-Funded Strategy(s): (Select all that apply)
Strategy 2: Assess Antimicrobial Resistance in Enteric Pathogens
Strategy 3: Assess Antimicrobial Resistance in Fungal Pathogens
Strategy 4: Assess Antimicrobial Resistance in Invasive Bacterial and Respiratory Pathogens
Strategy 5: Assess Antimicrobial Resistance in N. gonorrhoeae
Please list all project pathogens (by strategy area):
Please answer the following questions about this organization’s experiences with project implementation1. Please use information that will be included in this organization's Year 3 performance narrative submission.
PROJECT IMPLEMENTATION |
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Q ID |
Question |
Answer options |
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1. |
How many countries is this project being implemented in during BP3? |
Integer |
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2.
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What is the number of sites (laboratories, hospitals, healthcare facilities, etc.) that were supported as part of the project? Please answer for each country. |
List countries as follows: 1. [Country Name], [# of sites]; 2. [Country Name], [# of sites] |
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3. |
How many sites received direct material support (i.e., lab reagents/diagnostics, other lab equipment, IT material, printed SOPs, etc.) from this organization during this budget period as part of the project? Please answer for each country. |
List as follows: |
(will try to make this an autofill question, based on answer to #2) |
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1. [Country Name], [# of sites]; 2. [Country Name], [# of sites]; 3. … |
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4.
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Is this project contributing to achieving the goals of a country’s national action plan (NAP) on antimicrobial resistance? |
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c) No ( 4.c.) |
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d) Don’t Know |
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e) Does not apply/No NAP has been developed in any target country(s) |
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4.a./b. |
If yes, please list all countries and describe supporting activities of NAP (Open-ended) |
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4.c. |
If no, please list barriers to participation and/or support of the NAP (Open-ended) |
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5. |
List any major product(s) (e.g., SOPs, job aids, manuscripts, posters, trainings, etc.) developed within this budget period and specify location (if applicable).
If none, enter N/A |
Open ended |
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6. |
Have CDC Subject Matter Experts (SMEs) reviewed the major products listed in question #5? |
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6.b. |
If no, please explain (Open ended) |
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7. |
What strategies or activities has this organization implemented to sustain the efforts and progress made with this project beyond the current budget period? Beyond the funding cycle? |
Open ended |
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Please use this space to include any additional information related to implementation of this project. |
Open ended |
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Please answer the following questions based on this organization’s current laboratory capacity enhancement activities for this Global AR Lab & Response Network project. Please use information that will be included in this organization’s Year 3 performance narrative submission and be as thorough as possible.
LABORATORY CAPACITY SUPPORT |
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Q ID |
Question |
Answer options |
Notes |
1. |
Is regular external2 quality assurance performed for AR testing at this project’s participant laboratories? |
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1.a. Please describe: |
i. The type and frequency of these (e.g., WHO external program, PulseNet EQA, 2 bacterial specimens/ year for identification and AST, etc) (Open ended) |
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ii. The total number of participant laboratories currently enrolled. (Open ended)
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2. |
Is there a national or central laboratory3 which performs quality assurance testing for this project?
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a) Yes ( 2.a.) |
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2.a. If yes, please: |
i. List the number of labs where QA was performed by country (Open ended) |
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ii. List the total number of participant laboratories currently enrolled per country (Open ended) |
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3.-6. During the current budget period, has this organization provided training or support to any laboratories in the following areas? (Yes/No) If yes, section will expand with follow up questions |
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3. |
PHENOTYPIC TESTING |
a) What is the total number of labs at which training or other capacity building activities for performing phenotypic testing were implemented. (Integer - Enter 999 if unknown) |
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b) Describe the education and training standards held to determine proficiency4 in phenotypic testing. (Open ended - Enter N/A if unknown) |
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4. |
GENOTYPIC TESTING
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a) What is the total number of labs at which training or other capacity building activities for performing genotypic testing were implemented. (Integer - Enter 999 if unknown) |
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b) Describe the education and training standards held to determine proficiency in genotypic testing. (Open ended - Enter N/A if unknown) |
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5. |
ANTIMICROBIAL SUSCEPTIBILITY TESTING (AST), INCLUDING ANTIFUNGAL SUSCEPTIBILITY TESTING (AFST) |
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(Integer - Enter 999 if unknown) |
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(Open ended - Enter N/A if unknown) |
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6. |
WHOLE GENOME SEQUENCING (WGS) |
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(Integer - Enter 999 if unknown) |
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(Open ended - Enter N/A if unknown) |
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Please use this space to include any additional information related to this organization's laboratory capacity activities. |
Open ended |
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Please answer the following questions based on current surveillance efforts for this organization's Global AR Lab & Response Network project. Do not answer questions based on future efforts.
SURVEILLANCE CAPACITY |
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Q ID |
Question |
Answer options |
Notes |
1. |
Are epidemiological data elements collected with samples tested under this project? |
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1.a. If yes, please |
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1.b. If no, please |
i. List the barriers to collecting epidemiological data elements at sites? (Open ended)
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2. |
Are the collected data (e.g., phenotypic, genotypic, and NGS) integrated into subnational, national, or global databases?
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b) No ( 2.b.) |
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c) Don’t Know |
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2.a. If yes, please |
i. Describe what database(s) the data were reported to. Please list all. (Open ended)
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ii. Indicate the frequency of data sharing with national-level decision makers (e.g., MoHs, NPHIs, etc.)? (Open ended)
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2.b. |
If no, please list the barriers experienced. (Open ended) |
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3. |
Have any alerts5 or findings from the lab or facility required a local response (e.g., within facility or local area, data sharing, PPS, etc.)
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a) Yes ( 3.a.) |
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b) No |
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c) Don’t Know |
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3.a. |
If yes, please list the entities involved, response activities, and how data was shared. (Open ended) |
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Have any alerts or findings from the lab or facility been detected which required a sub-national or national response (e.g., new organism/type of resistance or large outbreak)? |
a) Yes ( 4.a.) |
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b) No |
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4.a. |
If yes, please list the entities involved, response activities, and how data was shared. (Open ended) |
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Please use this space to include any additional information related to this organization's surveillance capacity building activities. |
Open ended |
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The following questions cover current education and training activities for different personnel targeted by this Global AR Lab & Response Network project. Do not answer questions based on future efforts, only established or current opportunities.
Workforce Development Capacity |
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Q ID |
Question |
Answer options |
Notes |
Personnel Types |
Please select the type of personnel that received training from this organization (can be in collaboration with partners):
(select all that apply) |
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1.-5. For each personnel type selected above, please answer the following: |
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1. |
How many CDC-supported6 education and training opportunities have targeted [insert personnel type] personnel? |
a) Yes |
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2. |
Are there any other partnerships (e.g., universities, hospitals, etc.) that provide mentorship for [insert personnel type] personnel targeted by this project? |
a) Yes ( 2.a.) |
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2.a. |
If yes, please list these partnerships. (Open ended) |
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3. |
How many [insert personnel type] personnel received training? |
(Open ended) |
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4. |
Has a training curriculum been established for training [insert personnel type] personnel? |
a) Yes ( 4.a.) |
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4.a. If yes, |
i. Does the curriculum leverage a Train-the-Trainer model? (Yes/No) |
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ii. What entity is responsible for facilitating the curriculum? (Open ended) |
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iii. What assessments were conducted to ensure trainings addressed knowledge gaps? (Open ended) |
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5. |
Has competency testing been performed among the trained [insert personnel type] personnel? |
a) Yes ( 5.a.) |
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b) No ( 5.b.) |
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5.a. |
If yes, how often is this assessed? (Open ended) |
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5.b. |
If no, why hasn’t competency testing been performed? (Open ended) |
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Please use this space to include any additional information about this organization’s workforce development activities related to this project. |
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-----------------------------------------------END OF FORM 1 ---------------------------------------------------------------
The following questions are related to project implementation with partners as well as referral network and surveillance practices at EACH hospital, health care facility (HCF) and/or laboratory that is participating in [name of organization autofill]'s Global AR Lab & Response Network project.
Please complete one form per partner, HCF/hospital, or laboratory. Recipients with projects in multiple countries or engaged with multiple partners or HCFS/hospitals/laboratories will be asked to specify country and partner/facility name on each form.
Partner Name*:
We are defining the term “partners” broadly to include partners that this organization regularly collaborates with or engages as part of the activities for this project. This can include national and sub-national level government ministries; individual healthcare facilities, hospitals and/or individual laboratories; academic partners; other non-governmental organizations (NGOs); etc.).
Examples: Country X MoH; Local hospital or HCF; Private laboratory; etc.
Is this partner a laboratory or healthcare facility with lab?
i. Yes ( Complete entire form for this site)
ii. No ( Respond to “**Alternative 2” & STOP once Section 1 is complete)
Select the option that best describes this partner’s location (i.e., where is this partner based?):
Country capital or national level
State or provincial level
District or local level site
Private facility or laboratory site
Other (Please specify): ________________________
**Alternative 2. Select the option that best describes this partner: (If No selected above)
Government ministry (national or sub-national)
Private Industry
Academic Institution
NGO
Other (Please specify): ________________________
Name of partner’s location:
Name of country: – country drop down menu
Project contribution(s) made by this partner7 (e.g., equipment and supplies procured, trainings provided, isolates collected and submitted, etc.):
Q ID |
Question |
Answer options |
Notes |
6. |
Select the implementation phase that best describes this partner’s and/or or project site’s stage in the project, as it currently stands: |
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Please use this space to provide any additional context or information about project implementation phase with this partner. |
Open ended |
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The following questions cover current laboratory and/or referral network activities at the project site. This section is only completed for laboratories or HCFs with lab. Recipients will complete this section for each individual laboratory or HCF with lab site where project is being implemented. Do not answer questions based on future efforts, only established or current activities. Only answer questions based on project’s pathogen of interest.
LABORATORY NETWORK ACTIVITIES |
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Q ID |
Question |
Answer options |
Notes |
7. |
Does this site participate in a laboratory network or referral network? (Only asked of laboratories or HCFs with lab) |
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8. |
Has this site agreed to (or is it required to) submit or forward isolates? (Only asked of laboratories or HCFs with lab) |
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9. |
Which of the following testing methods are routinely performed at this site/laboratory?
Select all that apply.
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For each test type selected above, please answer the following: |
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Open ended (Include targets and any automated platforms where possible) |
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ii. Total testing volume |
Open ended |
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iii. Total number of personnel that received training in testing method |
Integer |
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***e) Sequencing only |
iv. Total number of personnel trained to perform bioinformatics8 analysis of WGS data |
Integer |
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v. Describe the bioinformatics pipelines being utilized to analyze data |
Open ended |
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10. |
Does this site have a program or any activities that focus on retaining staff9 with institutional and technical knowledge once they are trained on any of the testing methods listed previously? |
a) Yes ( 10.a.) |
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10.a. |
If yes, please describe: |
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11. |
Describe how laboratory data and results are managed and what platform (e.g., Laboratory Information Management System (LIMS), etc.) is used for data management at this laboratory/facility.
Where applicable, describe data management in the field or at point of collection (e.g., environmental surveillance sites, etc.) as well as in the lab. |
Open ended |
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Please use this space to include any additional information about this partner/ laboratory/ healthcare facility |
Open ended |
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-----------------------------------------------END OF FORM 2------------------------------------------------------------------
-----------------------------------------------END OF PM TOOL------------------------------------------------------------------
1 Implementation: The execution or practice of a plan, a method, or any design, idea, model, specification, standard or policy for doing something. As such, implementation is the action that must follow any preliminary thinking for something to happen.
2 External – meaning an organization or entity other than the local government
3 National or central laboratory within country
4 Proficiency defined as possessing a high degree of competence, expertise or skill in execution of tasks or demonstration of knowledge related to specific subject matter
5 Alert: Any newly detected** antimicrobial resistance findings that may influence surveillance and control practices.
** Examples of newly detected antimicrobial resistance include:
Exceptional phenotypes that have not previously been reported or are very rare; and
Novel resistance genotypes that are associated with mechanisms of resistance that have a high public health impact (i.e., high potential for spread and health impact) or pose serious challenges in laboratory detection and surveillance
Source: GLASS Emerging antimicrobial resistance reporting framework (GLASS-EAR)
6 CDC-supported refers to any training activities or opportunities where CDC provided support in some way, either through training materials, technical assistance and training, logistical support, etc. This DOES NOT refer to funding provided by CDC.
7 This can apply to the partner as a whole or contributions made at the individual lab site level
8 Bioinformatics: The science of collecting and analyzing complex biological data.
9 Refers to any efforts undertaken by the local/national government or other partners to ensure that institutional knowledge remains at the laboratory site
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Stahl, Anna (CDC/DDID/NCEZID/DHQP) (CTR) |
File Created | 2024:12:23 00:20:08Z |