Enabling optimal antimicrobial use in East Africa

Lead Research Organisation: Liverpool School of Tropical Medicine
Department Name: Clinical Sciences

Abstract

Recently, there has been an increasing awareness of the global threat to human and animal health that is presented by the failure of germs, specifically bacteria, to respond to treatment with medicines which formerly killed them, a phenomenon known as Antimicrobial Resistance (AMR). Many approaches are being explored to ameliorate this problem, including the critical need to make better use of antibiotics. Optimal use of antibiotics must ensure both that people unwell with bacterial infections continue to have access to medicines that they need and bacteria do not have the opportunity to develop resistance to these "magic bullets". Huge investments have been made in improved laboratory capacity, which permits us to detect and describe AMR and report this problem through surveillance networks to governments and international agencies. These investments in laboratory surveillance have not been matched by enhanced surveillance of or interventions to improve antibiotic use (ABU), particularly in low income countries. We propose to bring together four Global Challenges Research Fund (GCRF) investments in the field of AMR in East Africa into a GCRF cluster. We will collectively take responsibility for reviewing and "synthesising" all of our ABU research findings from the East African context from across human and animal health. We will work together to co-design "an essential information package" to optimise ABU in the East African context and to define an intervention using this package to change ABU behaviours in communities and health systems.

Planned Impact

During the two stages of the "An Essential Information Package for Optimising Community Antibiotic Use in East Africa" we will:

1. Undertake synthesis of evidence data on antibiotic use and information availability across East Africa
2. Design and pre-test an essential information package
3. Generate strengthened engagement with the East Africa AMR community
4. Produce a validated approach to optimising ABU

The intended beneficiaries of our consortium include:

- Research and policy communities
- Communities and policy makers in which cluster is active
- Communities and policy makers in which cluster is active
- Users, dispensers and prescribers of antibiotics in community

Beneficiaries will benefit from this research through?

- Development of improved targets for optimising antibiotic use
- Development of an intervention to reduce AMR
- Improved understanding of febrile illness, ABU and AMR across a well-developed network
- Improved access to antibiotics for those who need it
- Improved use of antibiotics by those who receive them
- Reduced prevalence of Drug resistant Infection

Publications

10 25 50
 
Description 1. Systems and evidence synthesis: this group focused on the stakeholder mapping and evidence synthesis. The AMR consortiums (AMIS, DRUM, HATUA, SNAP) and the UCL Knowledge Lab, Technology-supported capacity building for AMR surveillance all shared key findings which then were synthesised as a report and literature review The information gathered then informed the planning of the workshops.

2. Communications: this group focused on the messaging, framing, examples and refreshing a logic model from the SNAP consortium. Also on developing a robust evaluation of different kinds of campaigns that informed the co-design of the workshops. A publication is also planned to publish the logic model and findings from this group and the evidence synthesis group.

3. Workshops in Malawi, Uganda and Tanzania: IDRC were the lead and delivered six workshops altogether. Three workshops focused on human health and three on animal health and they took place in December 2021. The intended purpose was to understand the factors that impact the flow of antibiotic drug information to end-users. These workshops were attended by healthcare professionals, drug regulators and policy makers. Full reports of the findings from these workshops were put together These reports confirming the stakeholder requirements will inform the second stage proposal and also a publication is planned to publish the results

4. Developing a second stage proposal: this was discussed and planned in the consortium meeting where all partners attended. Now the regular consortium meetings have established a network, this network will continue and complete the second stage proposal later in 2022/early 2023.
Exploitation Route The established network of UKRI Funded AMR consortiums will be writing a second stage proposal. The next second stage of this project will be where the outcomes are focused on achieving impact where the findings will be used by others. The first stage project which has now been completed was gathering and synthesising evidence, gathering stakeholder requirements, preparing a logic model and an approach to take forward for the next second stage. There are plans for 2 papers to be published from the findings of the above work streams and these papers will be useful for others researching optimal use of antibiotics.
Sectors Agriculture, Food and Drink,Healthcare,Pharmaceuticals and Medical Biotechnology

 
Description Establishment of a new interdisciplinary consortium addressing optimal use of antibiotics in the community in East Africa There are plans for 2 papers from the findings of the project and so these papers will be useful for others researching optimal use of antibiotics.
First Year Of Impact 2020
 
Description African Institute for Development Policy (AFIDEP), Malawi 
Organisation African Institute for Development Policy
Country Kenya 
Sector Charity/Non Profit 
PI Contribution The partnership is confirmed contractually, with a consortium agreement containing a workplan (submitted at proposal stage), an agreed budget and terms of reference for the Project Management Committee (PMC). The PMC is led by LSTM and includes representatives from AFIDEP and there have been regular meetings every 1-3 months. The PMC is responsible for the strategic direction of the project, ensure effective management of resources in the project and monitor the progress of project deliverables and outcomes.
Collaborator Contribution Attendance and inputs to the regular PMC meetings.. Also Inputs to the 4 sub groups completing the activities of the project: 1. Systems and evidence synthesis led by LSTM and University of St Andrews 2. Communications and messaging led by University of Glasgow 3. Workshops in Malawi, Uganda and Tanzania led by LSHTM and IDRC 4. Developing a second stage proposal, this partnership will be ongoing past the end of the project. (Early 2023 to submit the proposal)
Impact The consortium agreement has now been executed for this partnership. The established network of UKRI Funded AMR consortiums will be writing a second stage proposal. The first stage project which has now been completed was the partnership gathering and synthesising evidence, gathering stakeholder requirements, preparing a logic model and an approach to take forward for the next second stage. There are plans for 2 papers to be published from the findings of the work streams and these papers will be useful for others researching optimal use of antibiotics. The next second stage of this project will be where the outcomes are focused on achieving impact where the findings will be used by others.
Start Year 2020
 
Description London School of Hygiene and Tropical Medicine, UK 
Organisation London School of Hygiene and Tropical Medicine (LSHTM)
Country United Kingdom 
Sector Academic/University 
PI Contribution The partnership is contracted through a consortium agreement containing a workplan (submitted at proposal stage), an agreed budget and terms of reference for the Project Management Committee (PMC). The PMC is led by LSTM and includes representatives from LSHTM and there has been regular meetings every 1-3 months. The PMC is responsible for the strategic direction of the project, ensure effective management of resources in the project and monitor the progress of project deliverables and outcomes.
Collaborator Contribution Attendance and inputs to the regular PMC meetings.. Also Inputs to the 4 sub groups completing the activities of the project: 1. Systems and evidence synthesis led by LSTM and University of St Andrews 2. Communications and messaging led by University of Glasgow 3. Workshops in Malawi, Uganda and Tanzania led by LSHTM and IDRC 4. Developing a second stage proposal, this partnership will be ongoing past the end of the project. (Early 2023 to submit the proposal) LSHTM have provided in-kind contribution of time for the PI of AMIS (a UKRI funded AMR Consortium) to join the PMC Meetings and provide valuable inputs into the project.
Impact The consortium agreement has now been executed for this partnership. The established network of UKRI Funded AMR consortiums will be writing a second stage proposal. The first stage project which has now been completed was the partnership gathering and synthesising evidence, gathering stakeholder requirements, preparing a logic model and an approach to take forward for the next second stage. There are plans for 2 papers to be published from the findings of the work streams and these papers will be useful for others researching optimal use of antibiotics. The next second stage of this project will be where the outcomes are focused on achieving impact where the findings will be used by others.
Start Year 2020
 
Description The Infectious Diseases Research Collaboration (IDRC), Uganda 
Organisation Infectious Diseases Research Collaboration (IDRC)
Country Uganda 
Sector Academic/University 
PI Contribution The partnership is confirmed contractually, with a consortium agreement containing a workplan (submitted at proposal stage), an agreed budget and terms of reference for the Project Management Committee (PMC). The PMC is led by LSTM and includes representatives from IDRC and there has been regular meetings every 1-3 months. The PMC is responsible for the strategic direction of the project, ensure effective management of resources in the project and monitor the progress of project deliverables and outcomes.
Collaborator Contribution Attendance and inputs to the regular PMC meetings.. Also Inputs to the 4 sub groups completing the activities of the project: 1. Systems and evidence synthesis led by LSTM and University of St Andrews 2. Communications and messaging led by University of Glasgow 3. Workshops in Malawi, Uganda and Tanzania led by LSHTM and IDRC 4. Developing a second stage proposal, this partnership will be ongoing past the end of the project. (Early 2023 to submit the proposal) IDRC have provided in-kind contribution of time for a PhD Student work on AMIS (UKRI Funded MRC Consortium) to join the PMC and provide valuable inputs to the project.
Impact The consortium agreement has now been executed for this partnership. The established network of UKRI Funded AMR consortiums will be writing a second stage proposal. The first stage project which has now been completed was the partnership gathering and synthesising evidence, gathering stakeholder requirements, preparing a logic model and an approach to take forward for the next second stage. There are plans for 2 papers to be published from the findings of the work streams and these papers will be useful for others researching optimal use of antibiotics. The next second stage of this project will be where the outcomes are focused on achieving impact where the findings will be used by others.
Start Year 2020
 
Description University College London, UK 
Organisation University College London
Country United Kingdom 
Sector Academic/University 
PI Contribution The partnership is contracted through the consortium agreement containing a workplan (submitted at proposal stage), an agreed budget and terms of reference for the Project Management Committee (PMC). The PMC is led by LSTM and includes a representative from UCL; there has been regular meetings every 1-3 months. The PMC is responsible for the strategic direction of the project, ensure effective management of resources in the project and monitor the progress of project deliverables and outcomes.
Collaborator Contribution Attendance and inputs to the regular PMC meetings.. Also Inputs to the 4 sub groups completing the activities of the project: 1. Systems and evidence synthesis led by LSTM and University of St Andrews 2. Communications and messaging led by University of Glasgow 3. Workshops in Malawi, Uganda and Tanzania led by LSHTM and IDRC 4. Developing a second stage proposal, this partnership will be ongoing past the end of the project. (Early 2023 to submit the proposal) UCL has provided in-kind contribution of time for the PI of UCL Knowledge Lab, Technology-supported capacity building for AMR surveillance: Fleming Fund. They join PMC meetings and provide valuable inputs to the project.
Impact The consortium agreement has now been executed for this partnership. The established network of UKRI Funded AMR consortiums will be writing a second stage proposal. The first stage project which has now been completed was the partnership gathering and synthesising evidence, gathering stakeholder requirements, preparing a logic model and an approach to take forward for the next second stage. There are plans for 2 papers to be published from the findings of the work streams and these papers will be useful for others researching optimal use of antibiotics. The next second stage of this project will be where the outcomes are focused on achieving impact where the findings will be used by others.
Start Year 2020
 
Description University of Glasgow, UK 
Organisation University of Glasgow
Country United Kingdom 
Sector Academic/University 
PI Contribution The partnership is contracted through the consortium agreement containing a workplan (submitted at proposal stage), an agreed budget and terms of reference for the Project Management Committee (PMC). The PMC is led by LSTM and includes representatives from University of Glasgow and there has been regular meetings every 1-3 months. The PMC is responsible for the strategic direction of the project, ensure effective management of resources in the project and monitor the progress of project deliverables and outcomes.
Collaborator Contribution Attendance and inputs to the regular PMC meetings.. Also Inputs to the 4 sub groups completing the activities of the project: 1. Systems and evidence synthesis led by LSTM and University of St Andrews 2. Communications and messaging led by University of Glasgow 3. Workshops in Malawi, Uganda and Tanzania led by LSHTM and IDRC 4. Developing a second stage proposal, this partnership will be ongoing past the end of the project. (Early 2023 to submit the proposal) University of Glasgow has provided in-kind contribution of time for PI of SNAP (UKRI AMR Consortium) to join PMC meetings and provide valuable inputs to the project. University of Glasgow lead on one of the project subgroups progressing the deliverables and outcomes of the project (communications and messaging).
Impact The consortium agreement has now been executed for this partnership. The established network of UKRI Funded AMR consortiums will be writing a second stage proposal. The first stage project which has now been completed was the partnership gathering and synthesising evidence, gathering stakeholder requirements, preparing a logic model and an approach to take forward for the next second stage. There are plans for 2 papers to be published from the findings of the work streams and these papers will be useful for others researching optimal use of antibiotics. The next second stage of this project will be where the outcomes are focused on achieving impact where the findings will be used by others.
Start Year 2020
 
Description University of St Andrews. UK 
Organisation St. Andrews University
Country United States 
Sector Academic/University 
PI Contribution The partnership is contracted through the consortium agreement containing a workplan (submitted at proposal stage), an agreed budget and terms of reference for the Project Management Committee (PMC). The PMC is led by LSTM and includes representatives from St Andrews University and there has been regular meetings every 1-3 months. The PMC is responsible for the strategic direction of the project, ensure effective management of resources in the project and monitor the progress of project deliverables and outcomes.
Collaborator Contribution Attendance and inputs to the regular PMC meetings.. Also Inputs to the 4 sub groups completing the activities of the project: 1. Systems and evidence synthesis led by LSTM and University of St Andrews 2. Communications and messaging led by University of Glasgow 3. Workshops in Malawi, Uganda and Tanzania led by LSHTM and IDRC 4. Developing a second stage proposal, this partnership will be ongoing past the end of the project. (Early 2023 to submit the proposal) St Andrews University has provided in-kind contribution of time for PI's of HATUA (UKRI funded AMR Consortium) to join PMC meetings and provide valuable inputs to the project. St Andrews lead on one of the project subgroups progressing the deliverables and outcomes of the project (Evidence Synethesis).
Impact The consortium agreement has now been executed for this partnership. The established network of UKRI Funded AMR consortiums will be writing a second stage proposal. The first stage project which has now been completed was the partnership gathering and synthesising evidence, gathering stakeholder requirements, preparing a logic model and an approach to take forward for the next second stage. There are plans for 2 papers to be published from the findings of the work streams and these papers will be useful for others researching optimal use of antibiotics. The next second stage of this project will be where the outcomes are focused on achieving impact where the findings will be used by others.
Start Year 2020
 
Description UofG-USYD 
Organisation University of Sydney
Department Faculty of Veterinary Science
Country Australia 
Sector Academic/University 
PI Contribution Prof Zadoks was lead applicant (HAZEL; SNAP-AMR) or co-applicant on the proposals listed in ResearchFish and continues to contribute to ongoing activities despite having moved to the University in Sydney. The University of Sydney covers her salary as in-kind contribution to enable her to continue to contribute to meetings, publications, ResearchFish reporting, etc.
Collaborator Contribution All listed projects were initiated by the partners, including by Prof. Zadoks when she was still employed by the University of Glasgow.
Impact Prof. Zadoks continues to engage with several projects, including through meetings, preparation of manuscripts, and reporting in ResearchFish. Prof. Zadoks' time investment in various projects is still significant and is contributed in-kind by her current employer, the University of Sydney. Multiple disciplines are involved in each project, as reported under various projects where appropriate.
Start Year 2019
 
Description Malawi: Animal Health Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Malawi: Animal Health Workshop

Intended purpose: To understand the factors that impact the flow of antibiotic drug information to end-users.

Who attended: The workshops were attended by healthcare professionals, drug regulators and policy makers.

Outcome: Participants made suggestions of what would be acceptable and feasible information on antibiotic use to be shared with end users.
Year(s) Of Engagement Activity 2021
 
Description Malawi: Human Health Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Malawi: Human Health Workshop

Intended purpose: To understand the factors that impact the flow of antibiotic drug information to end-users.

Who attended: The workshops were attended by healthcare professionals, drug regulators and policy makers.

Outcome: Participants made suggestions of what would be acceptable and feasible information on antibiotic use to be shared with end users.
Year(s) Of Engagement Activity 2021
 
Description Tanzania: Animal Health Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Tanzania Animal Health Workshop

Intended purpose: To understand the factors that impact the flow of antibiotic drug information to end-users.

Who attended: The workshops were attended by healthcare professionals, drug regulators and policy makers.

Outcome: Participants made suggestions of what would be acceptable and feasible information on antibiotic use to be shared with end users.
Year(s) Of Engagement Activity 2021
 
Description Tanzania: Human Health Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Tanzania: Human Health Workshop

Intended purpose: To understand the factors that impact the flow of antibiotic drug information to end-users.

Who attended: The workshops were attended by healthcare professionals, drug regulators and policy makers.

Outcome: Participants made suggestions of what would be acceptable and feasible information on antibiotic use to be shared with end users.
Year(s) Of Engagement Activity 2021
 
Description Uganda: Animal Health Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Uganda: Animal Health Workshop

Intended purpose: To understand the factors that impact the flow of antibiotic drug information to end-users.

The workshops were attended by healthcare professionals, drug regulators and policy makers.
Outcome: Participants made suggestions of what would be acceptable and feasible information on antibiotic use to be shared with end users.
Year(s) Of Engagement Activity 2021
 
Description Uganda: Human Health Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Uganda Human Health Workshop

Intended purpose: To understand the factors that impact the flow of antibiotic drug information to end-users.

Who attended: The workshops were attended by healthcare professionals, drug regulators and policy makers.

Outcome: Participants made suggestions of what would be acceptable and feasible information on antibiotic use to be shared with end users.
Year(s) Of Engagement Activity 2021