Rapid consensus building to strengthen AMR surveillance in LMICs using One Health approach: a modified table-top exercise coupled with a Delphi study protocol.

introductionImplementing integrated One Health surveillance of antimicrobial resistance (OH-AMR) remains a challenge globally, particularly in developing countries. Resource limitations, infrastructural gaps and inadequate technical capacity often hinder adherence to standardised antimicrobial resistance (AMR) surveillance guidelines, resulting in suboptimal data coverage and quality in resource-constrained settings. Moreover, considerable disparities exist in the design and execution of OH-AMR surveillance systems across regions, further complicating global data harmonisation and comparative analyses. Therefore, considering the complex ecosystem of OH-AMR and its effective implementation in the low- and middle-income countries (LMICs), a consensus-based multidisciplinary research agenda should be prioritised. In recent years, the Delphi method has become a popular tool in systematic and bias-free consensus building on a certain research domain or complex topics. Therefore, with the overarching objective of setting an operational standard for OH-AMR surveillance in LMICs, we aim to perform a Delphi study by engaging the experts from relevant domains. METHODS AND ANALYSIS: To streamline the traditional time-consuming Delphi technique, we plan to implement a real-time Table-Top Delphi exercise for rapid consensus building. Moreover, to capitalise on the convention of experts from diverse fields in real-time, we propose to conduct the study during an international conference on AMR. With systematic modification in the Delphi technique, the study will be conducted in two rounds where the first round will be performed in real-time followed by a second round online. For this purpose, a set of questions being prepared based on the identified gaps in existing scientific literature, evidence and guidelines for OH-AMR will be used. The questionnaire will be dispatched on an electronic platform to accumulate the responses from the experts in real-time while ensuring the anonymity and controlled feedback. Consensus will be defined as 70% or more of respondents selecting the same option for a given question. Considering the engagement of stakeholders from multiple domains of the trifecta, a total of 50 participants will be recruited in the study to have 70% replicable consensus where responses from at least 40 participants are expected in both rounds. The outcome of this Delphi study will pave the way for the implementation of an optimised OH-AMR surveillance strategy, especially in the global south, leading to actionable outcomes. ETHICS AND DISSEMINATION: The study will be conducted in accordance with the guidelines of the Ethics Advisory Board, Leipzig University, Germany. The Ethics Advisory Board has no concern on the study protocol (2025.08.27_eb_348) in terms of research ethics. Before participating in the survey, individuals will be required to provide informed consent through the Welphi electronic platform (Yes/No options). Participation will be entirely voluntary, and participants may withdraw their consent and discontinue participation at any stage of the study. The findings of the study will be shared with the major stakeholders including the quadripartite organisations, global and regional networks on AMR and presented in international conferences and social media forums on AMR. The outcome of the study will be published in a peer-reviewed journal.