An evidence-based practice for the implementation of whole genome sequencing at a national reference laboratory in Colombia

Abstract

The evidence-based practice (EBP) in health has been described previously in health approaches. The technologies applied to health, such as whole genome sequencing (WGS), provide a better understanding of emerging risks as antimicrobial resistance in priority pathogens due to the massive data generation and the increased resolution in public health investigations. The information related to WGS implementation in low- and middle-income countries (LMICs) is scarce, and the cost and complexity have been described as challenges for the formal implementation. The strengthening of epidemiological surveillance and the incorporation of new technologies in the public health system are described in the health plans in Colombia. Therefore, this study aims to provide an EBP for the WGS implementation in pathogen laboratory surveillance at a national reference laboratory in Colombia. To accomplish this goal, a concept model resulted from the integration of implementing science elements contained in the Iowa model, the PRACTIS step-by-step framework and the end-user behaviors, the review of information, local research implementation, and previous experiences in WGS, were used to build a structured EBP as a theoretical proposal. The results evidenced a positive perception of the commitment in strategic stakeholders for future implementation of WGS as routine in pathogen surveillance in Colombia. The resulting structure of the EBP was built on strata, distributed in action levels, categories and parameters. The theoretical EBP was recognized, criticized and evaluated by groups of people from two national reference laboratories, in two different roles, as developers and as end-users. An advisor groups of experts were involved looking for the addressing of local barriers and recommendations. The EBP proposed in this study improved the knowledge and understanding of all the strategic audiences of the national action plan on WGS implementation requirements in a local context in Colombia. The EBP for WGS could be set as the first step to the formal implementation planning in a national reference laboratory in Colombia due to the synthesis and intuitive structure for all audiences. Additionally, the EBP also promotes quick and strategic driven WGS for all audiences on novel health initiatives locally. The EBP in LMICs could be an essential resource on health knowledge translation in local action and policies, overcoming access barriers and promoting the evidence-based decisions in health.