External quality assurance (EQA) network in South and South-East Asia: experience and results from an international EQA programme in One Health sector reference laboratories

Objectives: External quality assurance (EQA) is an objective tool to assess laboratories' diagnostic performance and their adherence to recognized international standards. External Quality Assessment in Asia (EQASIA) is an EQA network in South and South-East Asia established in 2020 with the aim of improving the quality of bacteriology diagnostics across all One Health sectors in the region. The aim of this paper is to provide a comprehensive overview of the EQA results collected from the EQASIA network and to assess improvements among the participating laboratories.
Methods: Six EQA rounds were conducted between 2021 and 2023, each composed of different panels of WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) and The Food and Agriculture Organization of the United Nations (FAO) priority pathogens of interest to both the human and animal health sector.
Results: Between 24 and 32 laboratories signed up for six EQA rounds (EQA1-6). Participating laboratories were able to isolate and correctly identify most of the isolates across the EQA panels except for the Campylobacter spp. and Enterococcus spp. panels. The overall performance of laboratories across the six EQAs was between 75% and 100% (average 93.3% and median 93.6%). The obtained results showed a significant improvement in laboratories' performance over time. 
Conclusions: Laboratory capacity development and quality assurance in a microbiology laboratory are of particular importance especially in the context of antimicrobial resistance (AMR) and One Health surveillance. The EQASIA programme has the potential to validate laboratories' performance in detecting important One Health pathogens, generating reliable data for effective surveillance to curb AMR.