CARE: COVID-19 and Antimicrobial Resistance in East Africa - impact and response

There is a growing worry that knock-on effects originating from the response to COVID-19 will cause greater threats to human health in the future. One such area is antimicrobial resistance (AMR) caused by the overuse of antibiotics (AB). Responding to COVID-19, governments have imposed restrictions on everyday life to stop the virus spreading. Whilst these may be successful in combating the virus, they are changing the way people seek medical help for infections, and the way in which people use ABs when they feel ill. In order to help make sure that ABs retain their effectiveness, we need to understand more about how COVID-19 is directly and indirectly impacting on AB use and availability in communities. To do this we are going to build on existing studies in Tanzania and Uganda. We will enrol patients who have symptoms of common diseases caused by bacteria, and find out about how they seek treatment and get and use ABs. In their communities, we will find out about the availability of ABs by interviewing doctors and sellers of ABs, and more widely, we will find out how community members have received and responded to health messages on COVID-19. Using this information we are able to assess change in the situation by comparing with our pre-COVID-19 research information from the same locations. This will help identify where behaviours have changed and whether antibiotics are been used unnecessarily, so that steps and measures can be identified and introduced that can help communities use antibiotics more effectively, and therefore reduce the risk of increasing AMR.

There is mounting evidence that COVID-19 prevention measures are changing patient treatment-seeking behaviours for other illnesses. This includes changes in antibiotic (AB) usage which risks driving up antimicrobial resistance (AMR). This is a priority concern within LMIC countries, including those of East Africa, where the circulating pathogen population is responsible for a high burden of infectious disease. This project will address the knowledge gap of the impact that COVID-19 is having on AB usage and provision, and gather evidence to inform policy and interventions to reduce inappropriate AB usage. Employing an interdisciplinary approach, we will conduct a program of research in Uganda and Tanzania to investigate the extent to which COVID-19 has changed health-seeking behaviour for common bacterial illnesses and the availability and usage of ABs. We will target three interconnected AMR domains: Landscape - we will investigate the impact of COVID-19 on formal health care providers' and community drug sellers' experiences and attitudes to antibiotic provision and response to official COVID-19 advice; Patients - in health clinics we will enrol patients and examine how COVID-19 restrictions are affecting patient treatment seeking, AB use, and understanding of illness, and for a subset we will assess shifts in the AMR profile of urinary pathogens; and Communities - we will investigate how community members have received and responded to health messages on COVID-19 and how perceptions about illness and medications may have altered. Data will be compared to baseline data from our ongoing study that was collected in the study areas pre-COVID-19 to investigate changes in AB usage and provision and linkage to COVID-19 disease and/or interventions. A synthesis of the findings will be provided to a range of stakeholders from communities to governmental, to help improve AB stewardship activities and messaging as part of the pandemic response in East Africa and beyond.