Holistic Approach To Unravel Antibacterial resistance in East Africa (HATUA)

Lead Research Organisation: University of St Andrews
Department Name: Sch of Medicine

Abstract

The potential harm that increasing levels of antibacterial resistance (ABR) will have on human health is vast, as a consequence the effects of this will be felt across society and at the economic level. It is predicted that by 2050, 10 million lives per year and a cumulative 100 trillion US Dollars of economic output may be lost worldwide. In order to address this looming problem a co-ordinated global response is required to try and halt the rise of ABR. Efforts are underway to tackle the rise in resistance, however agenda-setting is dominated by High Income Countries (HICs) and may not reflect priorities or needs of Low and Middle Income Countries (LMICs), where the levels of resistance and also the types of disease caused by bacteria may be different.

One of the most vulnerable regions to the increase in antibiotic resistance is Africa where, in comparison to other regions of the world, the burden of infectious diseases is highest. The economic, cultural and ethnic diversity of Africa mean that the problems surrounding ABR across African countries are likely be distinct from other regions of the world, and therefore require regional solutions and approaches. For example, the availability of antibiotics can be patchy, and the routes of access to antibiotics are variable (including traditional healers, public and private medical practitioners and over-the- counter antibiotic access). Social, cultural and lifestyle drivers of ABR in Africa also have specific features - closer communal living in cities with variable water/sanitation, and closer animal husbandry in rural communities.
This project aims to address ABR in Africa and fill the gaps in knowledge. The research will target three main areas that comprise the problem: the bacteria that are antibiotic resistance and cause disease; the amount of antibiotics that are used to treat disease; and the behaviour of humans that governs how antibiotics are used and supplied. The three elements incorporate epidemiological, economic, cultural and societal factors that interact and contribute to the problem.

Bringing together research covering these 3 elements will provide a holistic view of ABR in East Africa. The project will establish a surveillance network across Uganda, Kenya and Tanzania that is comprised of sentinel sites that monitors and characterized the ABR bacteria that cause disease at that location, maps the use of antibiotics in the sentinel hospitals and the surrounding communities, and captures the behaviour and attitudes of humans that is responsible for their use in these setting. The project also recognises antibiotics are not exclusively used for human medicine, therefore our surveillance will also cover the use of antibiotics in veterinary medicine in the linked communities to provide a 'One Health' view. Using a multidisciplinary approach, encompassing, microbiology, genomics, epidemiology, statistics, social sciences and geography, we will seek to explore and describe the relationships between the elements, and identify the drivers of ABR.

Using this knowledge, we will identify interventions, such as public health and infection control measures and legislation changes, that can be made to control ABR at national and regional level. At the global level, the output of this project will add to the worldwide picture of ABR. This information will also be of value to global development agencies such as the WHO and FAO, to direct funding into effective interventions critical to the region.

Technical Summary

Researchers investigating antibacterial resistance (ABR) where there is a paucity of information are faced with challenges of data collection, linkage and resolution. We have designed our experimental workflows to utilize techniques and methods that will provide high-resolution and accurate data.
A crucial element of our project is the quantification and characterisation of the clinical burden of ABR. Working with microbiology labs that form the consortium's network, we will standardize Antibiotic Sensitivity Testing (AST) methodologies across labs, so that it meets EUCAST/CLSI guidelines, generating robust and comparable data. We will implement WGS within ABR within the surveillance network, and develop bioinformatics to enable local and international comparison of data for key indicator ABR organisms. We will deploy an intuitive user-friendly bioinformatics web application (microreact.net) to enable network laboratories to view WGS data contextually (i.e. in a geographic and phylogenetic context, with accompanying meta-data).

In order to gather antibiotic usage data across multiple sites we will equip researchers with mobile devices running EpiCollect software, to record quantitate and qualitative antibiotic data gathered from interviews. EpiCollect allows the generation of custom questionnaires, and uploading of data in the field, to a remote server which displays on a project website that can be used for data analysis and visualisation. The software also records geospatial information to enable geographically mapping of data. Simulated scenarios and in-depth interviews will be conducted to examine attitudes and behaviours around antibiotic prescription, administration and adherence. EpiCollect will also be utilized for this work to promote data linkage. Integrated mathematical and statistical analyses will be undertaken on our multi-disciplinary datasets to help construct and parameterise mechanistic models of the genesis and spread of ABR in East Africa.

Planned Impact

A key deliverable of this project is the development and provision of a microbiological surveillance network in East Africa. The network will provide a mechanism for antibacterial resistance (ABR) surveillance, gathering high quality diagnostic and phenotypic data for ABR pathogens, and will allow stakeholders to identify and provide early warning of resistances spreading within the region. A high-resolution view of ABR pathogens identified by the network will be provided by whole gene sequencing (WGS), to allow stakeholders to identify the genetic basis of resistance in isolates, and also identify high risk clones that are spreading locally, or are imported into the region from elsewhere.

The primary initial beneficiaries will be members of the microbiology network laboratories receiving training in microbiological testing, and also whole genome sequence analysis within clinical microbiology. As a result of the network structure, we anticipate that this will trickle down to connected laboratories, facilitating the extended use of data. Data- sharing with other regions will promote a more complete understanding of pathogen epidemiology and ABR.

WGS data can be used to identify local spread of drug resistance clones and also identify potential reservoirs of drug resistant pathogens. Evidence from the network will point to areas within the hospitals and the community where spread is more likely, and therefore help target resources and infection control initiatives more effectively. For healthcare policy makers at the national level, this information will help identify where there are gaps in policy, or there are changes required, which will more effectively combat the growing threat of ABR. Consequently, we anticipate that the consortium's actives will help inform stewardship guidelines for usage and treatment guidelines. The WGS data for the antibiotic resistant organisms will be of interest to around the world researchers interested in understanding pathogen evolution and the spread of AMR. The availability of accompanying high quality phenotypic data will also be of value to researchers interested in the genetic basis of resistance.
The work of the consortium will help legislators and government officials ascertain the extent and nature of the ABR problem in their country, and consequently provide evidence the risk that these pose. Our analysis of the behaviours and attitudes to antibiotics will highlight the drivers of resistance in their population that may require legislation to control the supply and use of antibiotics for human and animal consumption.

Our study across multiple sites and countries in East Africa will benefit governmental organizations and NGO's involved in the provision and management of public health, providing both country-specific and regional perspectives of ABR. This will inform where resource should be targeted, and also where policy co-ordination is required.

Publications

10 25 50
 
Description HATUA has established an East African AMR Surveillance Network that is now operating across three countries, Uganda, Tanzania and Kenya. In this network HATUA is collecting a wide range of data types, including quantitative biomedical and social data, and qualitative social data collected from UTI patients, healthcare providers and community members. The surveillance network has revealed a high level (60%+) of multi-drug resistance (MDR) in the study sample.
Exploitation Route Findings from HATUA's AMR surveillance network will be disseminated to collaborators, stakeholders and the wider community. As such, it will provide a depth of understanding of the problem of AMR not currently available in East Africa. In the short-term, this will allow doctors to access information they can use to improve diagnosis and prescription patterns based on resistance profiles prevailing locally. There is scope to extend the activities of the surveillance network to other regions in Africa.
Sectors Healthcare

 
Description Building diagnostic capacities for culture and susceptibility testing in study health clinics
Geographic Reach Africa 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact HATUA is building capacity by equipping labs, introducing diagnostic testing, and training local healthcare professionals. Culture and susceptibility results are now used for routine patient care in study clinics (Uganda, Tanzania, Kenya). Many of these clinics did not have access to microbiology diagnostics prior to HATUA. For example, microbiological testing has been introduced for the first time at Sengerema District Hospital in NW Tanzania and in level 3 clinics in Nakasongola, Uganda. This work delivers immediate improvements in patient care in remote communities.
 
Description HATUA findings contributing to development of National UTI Treatment Guidelines, Tanzania
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
 
Description Development of a Bayesian network approach for analysing interdisciplinary social science and biological data: the case of antimicrobial resistance (supervisors Keenan, Smith, Holden)
Amount £79,000 (GBP)
Organisation Scottish Graduate School for Social Sciences 
Sector Academic/University
Country United Kingdom
Start 09/2020 
End 08/2024
 
Description East African interdisciplinary consortium on AMR: HATUA, SNAP, DRUM, AMIS, University of Malawi 
Organisation Antimicrobials in Society
Sector Charity/Non Profit 
PI Contribution The aim of this collaboration is to develop an East African AMR PhD cohort. The collaboration continues our ongoing partnership with colleagues from DRUM, and SNAP and extends the working group to include AMIS and the University of Malawi. An application as been submitted for the DELTAS call: Developing Excellence in Leadership, Training and Science in Africa
Collaborator Contribution See above - waiting outcome of application
Impact None yet
Start Year 2020
 
Description East African interdisciplinary consortium on AMR: HATUA, SNAP, DRUM, AMIS, University of Malawi 
Organisation Liverpool School of Tropical Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution The aim of this collaboration is to develop an East African AMR PhD cohort. The collaboration continues our ongoing partnership with colleagues from DRUM, and SNAP and extends the working group to include AMIS and the University of Malawi. An application as been submitted for the DELTAS call: Developing Excellence in Leadership, Training and Science in Africa
Collaborator Contribution See above - waiting outcome of application
Impact None yet
Start Year 2020
 
Description East African interdisciplinary consortium on AMR: HATUA, SNAP, DRUM, AMIS, University of Malawi 
Organisation University of Glasgow
Country United Kingdom 
Sector Academic/University 
PI Contribution The aim of this collaboration is to develop an East African AMR PhD cohort. The collaboration continues our ongoing partnership with colleagues from DRUM, and SNAP and extends the working group to include AMIS and the University of Malawi. An application as been submitted for the DELTAS call: Developing Excellence in Leadership, Training and Science in Africa
Collaborator Contribution See above - waiting outcome of application
Impact None yet
Start Year 2020
 
Description East African interdisciplinary consortium on AMR: HATUA, SNAP, DRUM, AMIS, University of Malawi 
Organisation University of Malawi
Country Malawi 
Sector Academic/University 
PI Contribution The aim of this collaboration is to develop an East African AMR PhD cohort. The collaboration continues our ongoing partnership with colleagues from DRUM, and SNAP and extends the working group to include AMIS and the University of Malawi. An application as been submitted for the DELTAS call: Developing Excellence in Leadership, Training and Science in Africa
Collaborator Contribution See above - waiting outcome of application
Impact None yet
Start Year 2020
 
Description GCRF Challenge Cluster: An Essential Information Package for Optimising Community Antibiotic Use in East Africa 
Organisation African Institute for Development Policy
Country Kenya 
Sector Charity/Non Profit 
PI Contribution Dr Mike Kesby and Prof Matt Holden are part of this GCRF Cluster collaboration with colleagues from SNAP and DRUM consortia. The project will design an essential information package that considers both the materials used to covey information and the implementation processes necessary to support the optimal use of antibiotics in communities across East Africa. This will include a comprehensive evidence synthesis of the rich data from existing GCRF grants on ABU across our study settings (HATUA, SNAP and DRUM).
Collaborator Contribution The collaboration has just been awarded funding and the partners will shortly commence work on key activities, which includes the design of materials for sharing information on infections and how best to treat them, respecting the differing needs of different communities. This will entail a one health approach operating with local stakeholders at multiple levels of animal and human health sectors, targeting antibiotic users, drug providers and health workers as well as their social networks, plus the political, regulatory and organisational context in which they are situated.
Impact None yet
Start Year 2020
 
Description GCRF Challenge Cluster: An Essential Information Package for Optimising Community Antibiotic Use in East Africa 
Organisation Liverpool School of Tropical Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Dr Mike Kesby and Prof Matt Holden are part of this GCRF Cluster collaboration with colleagues from SNAP and DRUM consortia. The project will design an essential information package that considers both the materials used to covey information and the implementation processes necessary to support the optimal use of antibiotics in communities across East Africa. This will include a comprehensive evidence synthesis of the rich data from existing GCRF grants on ABU across our study settings (HATUA, SNAP and DRUM).
Collaborator Contribution The collaboration has just been awarded funding and the partners will shortly commence work on key activities, which includes the design of materials for sharing information on infections and how best to treat them, respecting the differing needs of different communities. This will entail a one health approach operating with local stakeholders at multiple levels of animal and human health sectors, targeting antibiotic users, drug providers and health workers as well as their social networks, plus the political, regulatory and organisational context in which they are situated.
Impact None yet
Start Year 2020
 
Description GCRF Challenge Cluster: An Essential Information Package for Optimising Community Antibiotic Use in East Africa 
Organisation University of Glasgow
Country United Kingdom 
Sector Academic/University 
PI Contribution Dr Mike Kesby and Prof Matt Holden are part of this GCRF Cluster collaboration with colleagues from SNAP and DRUM consortia. The project will design an essential information package that considers both the materials used to covey information and the implementation processes necessary to support the optimal use of antibiotics in communities across East Africa. This will include a comprehensive evidence synthesis of the rich data from existing GCRF grants on ABU across our study settings (HATUA, SNAP and DRUM).
Collaborator Contribution The collaboration has just been awarded funding and the partners will shortly commence work on key activities, which includes the design of materials for sharing information on infections and how best to treat them, respecting the differing needs of different communities. This will entail a one health approach operating with local stakeholders at multiple levels of animal and human health sectors, targeting antibiotic users, drug providers and health workers as well as their social networks, plus the political, regulatory and organisational context in which they are situated.
Impact None yet
Start Year 2020
 
Description HATUA Consortium partners in East Africa 
Organisation Catholic University of Health and Allied Sciences
Country Tanzania, United Republic of 
Sector Academic/University 
PI Contribution All members of the HATUA research consortium
Collaborator Contribution Colleagues from each partner organisation are co-investigators on HATUA
Impact Currently in start-up phase for project. Outputs still to emerge
Start Year 2018
 
Description HATUA Consortium partners in East Africa 
Organisation East African Health Research Commission (EAHRC)
Country Burundi 
Sector Charity/Non Profit 
PI Contribution All members of the HATUA research consortium
Collaborator Contribution Colleagues from each partner organisation are co-investigators on HATUA
Impact Currently in start-up phase for project. Outputs still to emerge
Start Year 2018
 
Description HATUA Consortium partners in East Africa 
Organisation Kenyan Institute for Medical Research (KEMRI)
Department KEMRI/CDC Research and Public Health Collaboration
Country Kenya 
Sector Charity/Non Profit 
PI Contribution All members of the HATUA research consortium
Collaborator Contribution Colleagues from each partner organisation are co-investigators on HATUA
Impact Currently in start-up phase for project. Outputs still to emerge
Start Year 2018
 
Description HATUA Consortium partners in East Africa 
Organisation Kilimanjaro Clinical Research Institute
Country Tanzania, United Republic of 
Sector Academic/University 
PI Contribution All members of the HATUA research consortium
Collaborator Contribution Colleagues from each partner organisation are co-investigators on HATUA
Impact Currently in start-up phase for project. Outputs still to emerge
Start Year 2018
 
Description HATUA Consortium partners in East Africa 
Organisation Makerere University College of Health Sciences
Department The Infectious Diseases Institute, Kampala
Country Uganda 
Sector Hospitals 
PI Contribution All members of the HATUA research consortium
Collaborator Contribution Colleagues from each partner organisation are co-investigators on HATUA
Impact Currently in start-up phase for project. Outputs still to emerge
Start Year 2018
 
Description HATUA Consortium partners in East Africa 
Organisation Uganda Virus Research Institute
Country Uganda 
Sector Public 
PI Contribution All members of the HATUA research consortium
Collaborator Contribution Colleagues from each partner organisation are co-investigators on HATUA
Impact Currently in start-up phase for project. Outputs still to emerge
Start Year 2018
 
Description HATUA Partnership with AMR Focal Points and Ministries of Health in Kenya, Tanzania and Uganda 
Organisation Ministry of Health and Social Welfare
Country Tanzania, United Republic of 
Sector Public 
PI Contribution The consortium has worked closely with key AMR stakeholders and Ministry of Health officials in Kenya, Tanzania and Uganda since HATUA's project inception meeting in Arusha Tanzania, July 2018. Our partners, who are responsible for National Action Plans in Kenya, Tanzania and Uganda, include: Dr Evelyn Wesangula, AMR Focal Point, Ministry of Health, Kenya Dr Siana Mapunjo, AMR Focal Point, Tanzania Prof Henry Kajumbula, Antimicrobial Resistance Surveillance Committee, Uganda The consortium has maintained regular contact with partners, providing feedback on progress, sharing and discussing preliminary findings.
Collaborator Contribution Most recently, our partners participated in a breakout session at the HATUA Consortium Meeting in Nairobi in December 2019. The session aligned HATUA research activities to the strategic objectives of each country's National Action Plan. As a result of these discussions, HATUA was asked by Siana Majunjo to contribute to national guidelines, including UTI treatment guidelines in Tanzania. Subsequently, Prof Stephen Mshana, was invited to attend Tanzania's National Antimicrobial Resistance Multi-Sectoral Coordination Committee (MCC) meeting that took place in mid-February 2020. Prof Mshana has been invited to give a further detailed presentation at the next MCC meeting in May 2020.
Impact UTI Treatment Guidelines, Tanzania (in prep)
Start Year 2018
 
Description HATUA Partnership with AMR Focal Points and Ministries of Health in Kenya, Tanzania and Uganda 
Organisation Ministry of Health, Kenya
Country Kenya 
Sector Public 
PI Contribution The consortium has worked closely with key AMR stakeholders and Ministry of Health officials in Kenya, Tanzania and Uganda since HATUA's project inception meeting in Arusha Tanzania, July 2018. Our partners, who are responsible for National Action Plans in Kenya, Tanzania and Uganda, include: Dr Evelyn Wesangula, AMR Focal Point, Ministry of Health, Kenya Dr Siana Mapunjo, AMR Focal Point, Tanzania Prof Henry Kajumbula, Antimicrobial Resistance Surveillance Committee, Uganda The consortium has maintained regular contact with partners, providing feedback on progress, sharing and discussing preliminary findings.
Collaborator Contribution Most recently, our partners participated in a breakout session at the HATUA Consortium Meeting in Nairobi in December 2019. The session aligned HATUA research activities to the strategic objectives of each country's National Action Plan. As a result of these discussions, HATUA was asked by Siana Majunjo to contribute to national guidelines, including UTI treatment guidelines in Tanzania. Subsequently, Prof Stephen Mshana, was invited to attend Tanzania's National Antimicrobial Resistance Multi-Sectoral Coordination Committee (MCC) meeting that took place in mid-February 2020. Prof Mshana has been invited to give a further detailed presentation at the next MCC meeting in May 2020.
Impact UTI Treatment Guidelines, Tanzania (in prep)
Start Year 2018
 
Description HATUA Partnership with AMR Focal Points and Ministries of Health in Kenya, Tanzania and Uganda 
Organisation Ministry of Health, Uganda
Country Uganda 
Sector Public 
PI Contribution The consortium has worked closely with key AMR stakeholders and Ministry of Health officials in Kenya, Tanzania and Uganda since HATUA's project inception meeting in Arusha Tanzania, July 2018. Our partners, who are responsible for National Action Plans in Kenya, Tanzania and Uganda, include: Dr Evelyn Wesangula, AMR Focal Point, Ministry of Health, Kenya Dr Siana Mapunjo, AMR Focal Point, Tanzania Prof Henry Kajumbula, Antimicrobial Resistance Surveillance Committee, Uganda The consortium has maintained regular contact with partners, providing feedback on progress, sharing and discussing preliminary findings.
Collaborator Contribution Most recently, our partners participated in a breakout session at the HATUA Consortium Meeting in Nairobi in December 2019. The session aligned HATUA research activities to the strategic objectives of each country's National Action Plan. As a result of these discussions, HATUA was asked by Siana Majunjo to contribute to national guidelines, including UTI treatment guidelines in Tanzania. Subsequently, Prof Stephen Mshana, was invited to attend Tanzania's National Antimicrobial Resistance Multi-Sectoral Coordination Committee (MCC) meeting that took place in mid-February 2020. Prof Mshana has been invited to give a further detailed presentation at the next MCC meeting in May 2020.
Impact UTI Treatment Guidelines, Tanzania (in prep)
Start Year 2018
 
Description Capacity Building in Microbiology 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Study participants or study members
Results and Impact A one-week Microbiology Course was held at UVRI Campus, Entebbe, Uganda in November 2018 for 20+ team members from Uganda, Tanzania, Kenya, USA and the UK. The aim of the course was to build capacity in lab skills and deliver training including the use of Epicollect and WHONET.
The event contributed to capacity building in microbiological techniques. Participants gained skills and knowledge, which they were able to share more widely on returning to local-level labs in the study areas.
Year(s) Of Engagement Activity 2018
 
Description Capacity building in Social Science Research on AMR 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Study participants or study members
Results and Impact A one-week event was held in Mwanza, Tanzania in December 2018 for 10+ team members from Uganda, Tanzania, Kenya, and the UK. The aim was to train a core group of colleagues in social science techniques (quantitative and qualitative), and to adopt standard operating protocols for consent procedures, patient surveys, interviews and focus group discussions.
The training contributing to capacity building in social science research techniques. Participants gained skills and knowledge, which they were able to share more widely when working in each study area.
Year(s) Of Engagement Activity 2018
 
Description Community-level focus group meetings and dissemination of information on UTI and AMR 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Study participants or study members
Results and Impact HATUA is engaging with members of local communities at each study location. In total, over 70 community level group discussions will be held; each group comprises 6-10 participants. Discussion participants are not linked to HATUA patients. Village Health Teams help recruit community members to participate in the discussions which are intended to capture information on healthcare seeking behaviours and AMR knowledge.
HATUA circulates information leaflets on a) UTI and b) AMR to all patients recruited to the study (approx. 5000).
These engagement activities raise awareness of antibiotic use and AMR.
Year(s) Of Engagement Activity 2018,2019,2020
 
Description District and community level inception meetings at study sites in Uganda, Tanzania and Kenya 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Prior to commencing patient recruitment, HATUA's research teams in Uganda, Tanzania and Kenya organise district and community level inception meetings at each field site to engage local communities and seek support. The participants include service users and practitioners from both human and animal care sectors, and key political and administrative stakeholders. In addition to general community meetings, hospital-level inception meetings are also held. For example, most recently, inception meetings were held at three hospitals in the Nairobi: Kiambu Hospital Level 5 (5/01/20), Kenyatta National Referral hospital (8/1/20), Mbagathi Level 5 hospital (11/1/20)
The inception meetings outline the HATUA study and raise awareness of AMR, which leads to increased knowledge across a large number of communities in East Africa.
Year(s) Of Engagement Activity 2018,2019,2020
 
Description East African Research Working Group to promote better health services (Prof Gibson Kibiki, EAHRC and Ministry of Health) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Prof Gibson Kibiki (EAHRC) has been running this engagement activity and providing mentoring since 2018. The most recent workshop was held in mid-December 2019 In Tanzania for research scientists, PhD students, Post-doctoral fellows, research administrators, statisticians, and clinicians. Representatives from the Tanzanian Ministry of Health also attended to officiate the event and discuss the role of research for better health services.

The aim is to encourage researchers across the region to continue working on health research and emphasise their work makes an important contribution to the strengthening of the health sector in East Africa.
Year(s) Of Engagement Activity 2018,2019,2020
 
Description G20 Health working group meeting, and WHO Regional Africa meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Prof Gibson Kibiki, HATUA Co-I and Executive Secretary of East African Health Research Commission (EAHRC) represented the HATUA Consortium at two formal working group meetings:
i) G20 Health working group meeting, 29 February 2020, Jeddah, Saudi Arabia
ii) WHO Regional Africa meeting in Brazzaville, Republic of Congo, August 2019
Year(s) Of Engagement Activity 2020
 
Description HATUA Research Twitter account 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The HATUA Research Consortium established a twitter account in 2018: @HATUA_Research. Social media plays a critical role in sharing information and engaging proactively with a wide audience including policymakers and practitioners.
Year(s) Of Engagement Activity 2018,2019,2020
 
Description Media engagement (TV, radio and press) 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact HATUA's research teams in Kenya, Tanzania and Uganda regularly engage with national media (TV, radio and press) to disseminate information about HATUA and more widely about AMR. For example, the Kenyan Country Lead, Dr John Kiiru from KEMRI, has been interviewed on Aljazeera English TV, Duetwelle Radio, and Kenyan national TV. In addition, on 25 November 2019, Dr Kiiru was interviewed by Kenya's People Daily newspaper in an article entitled "Over the counter drugs fuel deadly antibiotics resistance: collaborative effort only way to curb resistance". Also in November 2019, Dr Kiiru was an invited speaker on AMR in UTI infections at the National Antimicrobial Conference in Nairobi,
Engagement activities such as these raise awareness of AMR and lead to increased knowledge across a wide audience.
Year(s) Of Engagement Activity 2018,2019,2020
 
Description Participatory action research video and poster making project at Rubaya Community Hospital, Mbarara, rural Uganda 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact A small group of local community activists at a rural community in Mbarara were engaged in a two week project to explore the risks around AMR, review existing WHO (and other) health information material, and develop their own grassroots health information on AMR. The project was led by Dr Mike Kesby (St Andrews) with Prof Stella Neema (Makerere).

The purpose was to co-design AMR materials using the expertise and knowledge of local stakeholders to ensure correct messaging. The video and posters were presented to policymakers at the HATUA consortium meeting in Nairobi, December 2019.The presentation sparked good discussion on how to take this work forward.
Year(s) Of Engagement Activity 2019
 
Description Workshop on participatory digital methods 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact A research training workshop was held In St Andrews in March 2019. Attendees included HATUA social science colleagues from East Africa, colleagues from Glasgow's SNAP AMR GCRF project, and postgraduate students. Participants subsequently engaged with local communities in East Africa to disseminate training and ideas.
Year(s) Of Engagement Activity 2019