Evaluating the impact of a Lao language mobile phone antimicrobial use guideline application on antimicrobial prescribing in Laos (360G-Wellcome-214207_Z_18_Z)

Antimicrobial resistance (AMR) is a Lao major public health concern. We will evaluate whether Lao-language antimicrobial prescribing guidelines mobile phone application (app), will improve antimicrobial prescribing in in- and outpatients across Laos. Stepped wedge randomized controlled trial in six central/provincial hospitals will be performed. The intervention will be the guidelines mobile app. Hospital pairs will be randomly allocated to start the intervention (every eight months) until all have received the intervention. This will give 24 months for both control and intervention groups. Control period will start eight months before intervention. Outcome will be the changes in proportion of prescribing consistent with guidelines and the cost-effectiveness of the intervention. Point prevalence survey (PPS) on in- and outpatients antimicrobial usage will be performed every 4 months throughout the trial to collect prescribing data and hospital cost data. Hospitals will receive a training of guidelines handbooks usage at the control starts, training on the app usage at the intervention starts, PPS feedback and focus group discussion. AMR in Laos remains less severe than elsewhere in Asia, this simple technology may help reduce further worsening. This trial would have a significant impact in Laos, and inform policy globally, by improving prescribing and reducing AMR.