The purpose of this Request for Proposals (RFP) is to enter into a contractual agreement with a successful bidder and select a suitable contractor to develop a modelling framework for the use of individual and population-level clinical and microbiological data to systematically adapt WHO guidance for empiric antibiotic regimens.
WHO is an Organization that is dependent on the budgetary and extra-budgetary contributions it receives for the implementation of its activities. Bidders are, therefore, requested to propose the best and most cost-effective solution to meet WHO requirements, while ensuring a high level of service.
WHO leads global efforts to combat AMR, a growing public health threat that undermines our ability to treat infections. Given the inappropriate use of antimicrobials is a key driver of the emergence and spread of AMR, the Global Action Plan on AMR, through its fourth strategic objective, aims to optimize the use of antimicrobial medicines.
Recognising the importance of appropriate antimicrobial use in addressing AMR, Member States committed to achieving a target of having 70% of antibiotics used in human health being from the Access category during the United Nations General Assembly (UNGA) High-Level meeting on AMR in 2024. A multipronged approach at all levels of national health systems, supported by global guidance, is required to achieve this target. Current, evidence-based treatment guidelines integrating antimicrobial stewardship (AMS) principles form the basis of appropriate use, to help standardise and benchmark antibiotic use.
The WHO Access, Watch and Reserve (AWaRe) antibiotic book and other WHO guidelines on infection management have been developed using rigorous scientific approaches. In some situations, it may be suitable to adopt the recommendations without changes, while in others, adaptation to the country/facility context may be necessary. At the same time, AMS guidance often suggests modification of clinical guidelines, particularly empiric therapy options, based on local AMR data. However, AMR data are usually biased toward hospitalized patients (i.e. those who are more ill and complex, have had previous antibiotic therapy and are in an environment with transmission of multidrug-resistant organisms) and do not represent the majority of patients with community-acquired infections for which guidance on empiric therapy is utilised. Similarly, there is a paucity of evidence to guide when (e.g. at what resistance threshold) and how adaptation of guidelines should be performed. If treatment guidelines are indiscriminately modified based on biased AMR data, there is a risk for the overuse of broad-spectrum antibiotics and exacerbation of the AMR problem.
As such, there is a need to develop an evidence-based framework to guide the adaptation of treatment guidelines for different indications and in various contexts, based on available clinical, demographic, microbiological and genomic data at both the individual and population level and relevant modelling estimates. There is a particular interest in the adaptation of guidelines for enteric fever and neonatal sepsis given the burden of disease and ablility to make a diagnosis. In order to be useful, such a framework should address these two indications but also be applicable to a broader range of infectious diseases for which AMR data may be relevant in selecting the most appropriate empiric therapy.
