An extension of the WHO TRICYCLE project, TRIuMPH (Tricycle Upscaling Monitoring for Public Health) aimed to adapt and extend the TRICYCLE protocol on a national scale to achieve integrated AMR surveillance in Malaysia, Pakistan, and Madagascar. Launched in 2020 through an international consortium involving public health institutions, research laboratories, and training centers in Madagascar, the Netherlands, France, Malaysia, and Pakistan, the project came to an end in 2025.
Using simplified, harmonized methods, the project focused on Escherichia coli as an indicator species for multidrug-resistant bacteria. Found in human health, animal health, and the environment, E. coli enabled the circulation of AMR to be evaluated through all three pillars of the One Health concept. The improvements to the TRICYCLE protocol also included a search for carbapenemase-producing enterobacteriaceae (CPE) in all three sectors. The Mérieux Foundation was responsible for the molecular characterization of CPE strains isolated in the human sector in Madagascar, working with the ten hospital laboratories in the RESAMAD network and the Charles Mérieux Center for Infectious Disease in Antananarivo.
By taking a simplified, integrated approach to antimicrobial resistance surveillance, TRIuMPH demonstrated the feasibility of a transferable, sustainable, intersectoral model for national public health policies. The project received support from major funding organizations, including the Swedish International Development Cooperation Agency, which financed the JPIAMR program (Joint Programming Initiative on Antimicrobial Resistance) behind the project in Madagascar.
The closing meeting of the TRIuMPH consortium was held in September 2025 at the National Institute for Public Health and the Environment in the Netherlands. The results from the three countries where the project took place were presented to national ministries and international organizations, together with feedback about how the surveillance was implemented.
