Optimising community antibiotic use and infection control with behavioural interventions in rural Burkina Faso and DR Congo

Emergence of antibiotic resistance (AMR) is a serious concern for Low and Middle Income Countries (LMICs). Unregulated use of antibiotics, a major AMR driver, is highly prevalent in LMICs, with medicine stores as key providers. Physical interactions between One Health compartments increase cross-domain transmission risks, although the relative importance of different reservoirs is uncertain, with community- level dynamics of AMR in LMICs largely unquantified. We will develop and evaluate a behavioural intervention bundle, targeting medicine stores and their communities, to optimise antibiotic use and improve hygiene, and hence reduce AMR prevalence and transmission. After a 6-month local co-development phase, the intervention will be implemented over 12 months in established health demographic surveillance sites in Burkina Faso and DR Congo with clinical microbiology facilities, and evaluated in a cluster RCT, comparing intervention and control villages. The primary outcome measure is the change in Watch antibiotic provision from medicine stores (where a formal prescription is not required), assessed via patient exit interviews and simulated client visits. Changes in hygiene practices and AMR pathogen and gene carriage will be assessed in repeated population surveys. Rodents, living in close proximity to humans in much of sub-Sahara Africa, provide a proxy estimate of environmental AMR pathogen and gene exposure. Using modelling and sequencing of selected human and rodent isolates, we will quantify how changes in antibiotic use and hygiene practices impact AMR transmission.

Emergence of antibiotic resistance (AMR) is a serious concern for Low and Middle Income Countries (LMICs). Unregulated use of antibiotics, a major AMR driver, is highly prevalent in LMICs, with medicine stores as key providers. Physical interactions between One Health compartments increase cross-domain transmission risks, although the relative importance of different reservoirs is uncertain, with community- level dynamics of AMR in LMICs largely unquantified. We will develop and evaluate a behavioural intervention bundle, targeting medicine stores and their communities, to optimise antibiotic use and improve hygiene, and hence reduce AMR prevalence and transmission. After a 6-month local co-development phase, the intervention will be implemented over 12 months in established health demographic surveillance sites in Burkina Faso and DR Congo with clinical microbiology facilities, and evaluated in a cluster RCT, comparing intervention and control villages. The primary outcome measure is the change in Watch antibiotic provision from medicine stores (where a formal prescription is not required), assessed via patient exit interviews and simulated client visits. Changes in hygiene practices and AMR pathogen and gene carriage will be assessed in repeated population surveys. Rodents, living in close proximity to humans in much of sub-Sahara Africa, provide a proxy estimate of environmental AMR pathogen and gene exposure. Using modelling and sequencing of selected human and rodent isolates, we will quantify how changes in antibiotic use and hygiene practices impact AMR transmission.