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
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
Organisations
- Liverpool School of Tropical Medicine (Lead Research Organisation)
- Infectious Diseases Research Collaboration (IDRC) (Collaboration)
- University College London (Collaboration)
- UNIVERSITY OF GLASGOW (Collaboration)
- University of Sydney (Collaboration)
- London School of Hygiene and Tropical Medicine (LSHTM) (Collaboration)
- St. Andrews University (Collaboration)
- African Institute for Development Policy (Collaboration)
| Description | The EIP GCRF cluster took an interdisciplinary approach to considering the "intractable challenge" of community usage of antibiotics. This involved four consortia (AMIS, DRUM, HATUA, SNAP) and multiple other individuals, many of whom did not previously know each other came together to share unpublished data and learn from each other's experiences. The group completed evidence synthesis across multiple AMR consortiums (AMIS, DRUM, HATUA, SNAP) and the UCL Knowledge Lab, Technology-supported capacity building for AMR surveillance. The group mapped the flows of antibiotic information, providing a visual conceptualisation of the related complexity. In doing they considered the impact of time-space distancing by mapping the places where AB information is decoupled from access to drugs. The group considered points where populations can access 'good' information, though there is also a need to consider what individuals will do with that information once it is relayed. Secondary analysis was completed of available policy data from the DRUM project to understand the approaches and opinions of policymakers, medical professionals, and regulators to information provision around ABU. This work expanded the map, introducing further complexity and contributing to an understanding of how the current system(s) of information dissemination developed. The evidence synthesis in this area helped to map existing 'official' or 'authoritative' information dissemination, and understand information flow and decision-making within the systems, structures, and regulatory environment within which an 'Essential Information Package' (EIP) would be developed and implemented. Findings from these subgroups were synthesised into a map of antibiotic information flows from source to end users and the associated barriers to the utilisation of this information. A scoping review was conducted to clarify key concepts, determine the available evidence and highlight any gaps in the literature on information flows. These findings will be published soon. The Infectious Diseases Research Collaboration (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. These workshops were attended by 44 healthcare professionals, drug regulators and policy makers across the three countries. The intended purpose was to understand the factors that impact the flow of antibiotic drug information to end-users, in order to identify where interventions could provide end users with essential information about antibiotics. Full reports of the findings from these workshops were put together. Across the three countries stakeholders acknowledged that there was a scarcity of information often recommended by medical and veterinary professional bodies on ABU among end users and farmers. However, stakeholders expressed concern about sharing detailed information on ABU with end users and farmers. Stakeholders strongly felt that detailed information on ABU should only be shared with trained veterinary and medical professionals and extension workers. Sharing detailed information with end users and farmers was described by stakeholders as likely to drive further misuse of antibiotics as end users and farmers were seen as incapable of carrying out differential diagnosis and correctly administering these medicines. Stakeholders were of the view that a package of general information on use of medicines targeting the general public would be appropriate. For human health, the information package would focus on good practices around medicine use, storage, and disposal. In animal health, the focus would be on disease prevention, hygiene, vaccination, and biosecurity to minimise the need for antibiotics. Both information packages would discourage self-medication and encourage people to seek medical care from trained professionals. The findings from the stakeholder workshops confirming the stakeholder recommendations will inform the second stage proposal and a publication is under development to publish the results. |
| Exploitation Route | The established network of UKRI Funded AMR consortiums will be writing a second stage proposal. There are plans for 2 papers to be published from the findings discussed above . These papers will be useful for others researching optimal use of antibiotics. |
| Sectors | Agriculture, Food and Drink,Healthcare,Pharmaceuticals and Medical Biotechnology,Other |
| 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. Two papers are being published, the current status of the papers is that one paper has been submitted and the other paper is almost ready to be submitted. Once published these open access papers will be shared. |
| First Year Of Impact | 2020 |
| Sector | Agriculture, Food and Drink,Healthcare,Pharmaceuticals and Medical Biotechnology |
| 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 |