Multiple factors including the way antimicrobial agents are used in human medicine, agriculture and inability to implement medicines regulatory policies drive development and spread of antimicrobial resistance (AMR). The O’Neill Commission review warned that failure to act on AMR would result in an additional 10 million lives lost each year to drug-resistant strains of malaria, HIV, TB, and certain bacterial infections by 2050, at a cost to the world economy of 100 trillion USD. On the 21st of Sept 2016, the UN general assembly acknowledged AMR as a global health threat and declared their commitment to fight it. At this meeting, countries reaffirmed their commitment to develop national action plans on AMR, as stipulated in the Global Action Plan on Antimicrobial Resistance—the blueprint for tackling AMR. In line with the action plan, countries are expected to investigate the magnitude of the problem, stop misuse of antimicrobial medicines, strengthen surveillance systems to monitor anti-microbial infections and the volume used in humans, animals and crops.
Wilber speaking at the AMR conference
The purpose of the symposium, which was held on 31st March 2017 at Ecole technique professionnelle de bujumbura, Burundi was to put these issues into the East African Community perspective and draw points for AMR action plan for the region. The main goal of the symposium was to highlight what the EAC member States should do to prevent further emergence antimicrobial resistance, manage antimicrobial resistant infections while preventing their spread. Hosted as part of the 6th East African Health and Scientific Research Conference and International trade fair, the symposium was divided into two sessions: expert presentations to highlight the challenges and stimulate discussion and then panel discussion to put pertinent issues into perspective. The following topics were addressed:
The Global action plan on AMR: what implementation lessons can be drawn by the EAC?
Situation analysis of the use or misuse of antimicrobial agents in EAC in relation to the rest of Africa.
The magnitude, transmission dynamics, and drivers (biological, health system, socio-economic etc) of antimicrobial resistance in EAC.
The human – animal (and agricultural) interface impact on the use of antimicrobial agents and spread of antimicrobial resistance.
Do EAC member states have policy and regulatory framework on the use of antimicrobial agents – to what extent are these policies being practiced?
To what extent is research evidence being used in formulating policy on use of antimicrobial agents?
Situational analysis of the capacity (laboratory, clinical, community health etc) of health systems among EAC states to prevent or manage antimicrobial resistance
National antimicrobial resistance task forces – challenges and opportunities in addressing the use or misuse of antimicrobial agents.
TWENDE consortium sponsored the symposium co-chaired by Dr. Wilber Sabiiti of the University of St. Andrews and Dr. Helen Meme of Kenya Medical Research Institute (KEMRI). Dr. Sabiiti gave a prologue to the symposium bringing into context the World Health Organisations’ global action plan on antimicrobial resistance and implementation lessons for the EAC. Dr. John Ndemi Kiiru of KEMRI brought to the fore the situation analysis of AMR in East Africa highlighting the magnitude and drivers of AMR in the region. Dr. Kiiru further noted the importance of urbanisation along main transport networks as hotspots for AMR emergence and spread. Associate Professor Benon Asiimwe of Makerere University addressed the AMR challenge at the human-animal interface. He noted that the pastoralist communities in E. Africa have been neglected by the health system and thus resorted to self-medication sharing antibiotics with their livestock. These antimicrobials are most often sold in open markets under the trees in grazing fields. The panellists who included representatives of the Medicines regulatory bodies and AMR task forces in the EAC member states put into context the AMR challenges and the antimicrobial agents’ usage policy in the EAC. It was important to note that the problem wasn’t the absence of antimicrobial agents’ regulations but ineffective implementation of these exiting regulations. Mr. Fred Orina and Ms. Barbara Miheso of KEMRI gave the TWENDE perspective of translation of research into policy and practice as crucial for improving effectiveness of policy implementation and keeping research institutions relevant to healthcare delivery in the region.
AMR Conference in Bujumbura
Over 200 delegates: students, academics, healthcare professionals, policy makers, diplomats, business men & women, animal health practitioners, pharmaceutical industry professionals attended the symposium representing a broad spectrum of views from society. Practical recommendations came out of expert presentations, panel discussion and the audience and will be compiled into policy recommendation compact. The compact will be submitted to the East African Health Research Commission who will translate it into the EAC policy on antimicrobial agents and antimicrobial resistance policy and action plan.
While some parts of the world are now deploying 4th generation healthcare technological including diagnostic and treatment tools, some are still struggling to progress to 2nd generation. The question is how do we get everybody to access the best diagnostic tools? There are many answers to this question but the main ones are funding, training and partnership between policy makers and innovators. Dr Wilber Sabiiti has recently given a series of talks and training in different African countries showcasing the advantages of the molecular bacterial load assay (MBLA) and TWENDE work on developing model for rapid uptake of health research innovations into policy and practice.
Developed and optimised at University of St. Andrews, the MBLA is the first assay in the world of bacteriology to offer rapid molecular quantification of bacterial burden. Traditionally, bacterial load quantification has depended on grown on solid agar medium and counting the number of colonies. This approach works well if: the bacterial species rapidly grow on solid medium; 2) the entire species population grows on solid medium; and 3) the medium is effectively selective to inhibit other bacterial species from growth. The reverse is true with Mycobacterium tuberculosis (Mtb), which is a slow grower, proportion of its population doesn’t grow on artificial growth media and often the sample decontamination techniques fall short of removing non-mycobacterial organisms. The MBLA solves these challenges by offering a contamination-free rapid, sensitive and specific quantification of patient Mtb burden. Like viral load monitoring of antiretroviral treatment in HIV infection, MBLA monitors the response to anti-tuberculosis treatment by measuring the decline in bacterial load of a patient during treatment follow-up. The results are available in as little as 4h from the time reaches the lab. Read more of Dr. Sabiiti’s presentation to the department of Biomedical Sciences Stellenbosch University.
The Stellenbosch’s school of Biomedical sciences is leading research on host biomarkers of tuberculosis and working the Infection group at University of St. Andrews’ school of Medicine studies will be conducted to optimise and integrate microbiological and host biomarkers of tuberculosis disease and treatment response. Dr. Sabiiti gave MBLA training to postgraduate students in the department, some whom will be instrumental in driving the research and implementation of MBLA at Stellenbosch University. (attach photos of Wilber training the post graduate students).
Wilber presenting at KCRI
Innovation is not complete until the products are accessed by society. TWENDE is working to create channels for rapid uptake of health research innovations into policy and practice in E. Africa. Innovative tools like MBLA need to be integrated into the tuberculosis control policy so that they can be assessed by the people who most need them. Dr. Sabiiti gave talks at NIMR-Mbeya Medical Research Centre and Kilimanjaro Clinical Research Institute aimed at increasing the awareness of TWENDE work to all staff members who aren’t part of the TWENDE research team..
TWENDE aims at expanding to all East African Community (EAC) member states. To this end, Dr. Sabiiti visited the Medical Research Centre (MRC) team at the Rwanda Biomedical Centre to discuss opportunities for initiating research collaboration with the University of St. Andrews and the rest of the TWENDE partner institutions in the EAC.
TWENDE is building a model to increase effectiveness of implementing health research innovations. Using the implementation of tuberculosis (TB) molecular diagnostics, we are investigating the implementation barriers and ways to unlock them and make implementation a success. Released on the world TB day 24th March 2017, the results of Kenya national TB survey revealed higher prevalence than previously reported (https://ke.usembassy.gov/pr-03242017/). The report highlights the use of microscopy as the main tool for TB diagnosis to have missed many TB cases resulting in under reporting of the disease burden. The findings of this survey reaffirm the need for effective implementation of innovative diagnostic tools to reach the communities that most need them. TWENDE’s mission is to ensure that health research innovations are translated into policy and practice and are effectively implemented.
Dr. Wilber Sabiiti, the co-ordinator of TWENDE consortium has recently completed the TWENDE site monitoring visits in Kenya, Tanzania and Uganda and witnessed the great progress made. The TWENDE teams have been exploring the state of TB diagnosis and treatment through online survey of the county and or district medical officers and healthcare facility audits for implementation of TB diagnostics, Xpert MTB/RIF and Line probe assay. Over 70% of the survey and audits are complete across the three countries.
Preliminary analysis of the survey responses confirms microscopy as the main tool for diagnosis at 92% coverage almost two times higher than the Xpert MTB/RIF. Under funding is taking the lead as the main issue for low implementation of Xpert MTB/RIF. Other key issues are procurement difficulties, insufficient human resource and lack of awareness. Absence of utilities such as electricity and water is also mentioned. We will further explore these issues using interviews and focus group discussions with healthcare professionals, service users including TB patients and survivors, and policy implementers. Information emanating from these investigations will be used to engage policy makers with a view of developing a model for accelerating the implementation of effective diagnostic and treatment interventions at national and regional levels.
TWENDE Site Progress
The Kenya team is led by Kenya Medical Research Institute (KEMRI) centre for respiratory diseases research. The team has completed over 80% of the survey and health care facility audits. They will soon launch the qualitative data collection with interviews and focus group discussions and then policymakers’ engagement workshops in April – June 2017.
KEMRI TWENDE meeting
The Northern Tanzania team is led by Kilimanjaro Clinical Research Institute (KCRI). The team has completed over 90% of the survey and health care facility audits. They will soon start the qualitative data collection with interviews and focus group discussions aiming to finish end of May and then start policymakers’ engagement workshops in June – July 2017.
KCRI TWENDE meeting
The Southern Tanzania team is led by National Institute of Medical Research – Mbeya Medical Research Centre. The team has completed over 90% of the online survey and health care facility audits. They will soon start the qualitative data collection with interviews and focus group discussions aiming to finish end of May and then start policymakers’ engagement workshops in June – July 2017
TWENDE Meeting in Mbeya
The Uganda team is led by Makerere University School of Biomedical Sciences in collaboration with CPAR Uganda ltd. The team has completed around 50% of the work and have put in place contingency measures to expedite completion of the work. They will simultaneously conduct online survey and healthcare audits with aim of completing these by 15th April. Shortly after, qualitative data collection led by CPAR Uganda ltd will follow ending in June 2017. July – September will be used for engaging with policy makers.
Listen to Dr Wilber Sabiiti of the School of Medicine discussing the key aims of project TWENDE. This short video gives a great insight in to the project in an exciting month where the first knowledge translation training sessions began to build skills in translating research in to practice and policy. For more information on the project, which is funded by the European & Developing Countries Clinical Trials Partnership (EDCTP), please visit the TWENDE webpage.
Congratulations to Dr Wilber Sabiiti who has been selected to participate in the new Wellcome Trust programme for researchers; International Funders’ Award in Management Skills. Out of the many applicants, Wilber was one of only 10 researchers who were selected to participate, based on their motivation and commitment to undertake the programme, and will be one of the first researchers in the world to have the International Funders’ Award Certificate.
The award is run in partnership with the Bill and Melinda Gates Foundation, Medical Research Council, Institut Pasteur and BBSRC and its key objective is to increase productivity of research teams and, therefore, increase the chance of success in future grant applications. Modules will include: managing your research project, budgeting, writing scientific papers and reports, presentation and communication skills and recruiting the right person.
The TWENDE Knowledge Translation (KT) training begun yesterday at the School of Medicine University of St. Andrews. Our theme is, ‘To be useful to society, research knowledge must be translated into policy and practice’. Dr. Ewan Chirnside of the University of St. Andrews is leading the training and we are excited to have KT representatives from Kenya and Tanzania. Continue reading →
TWENDE was launched on 1st July 2016 at the Nelson Mandela African Institution of Science and Technology in Arusha, the capital of the East African Community. The conference brought together over 60 delegates including government representatives, researchers, development partners and students to discuss ways of accelerating translation of health research innovations in East Africa and Africa at large. Dr. Wilber Sabiiti and Dr. Ewan Chirnside of the University of St. Andrews delivered keynote adress on the role and impact of translating research into policy and practice. Wilber sought to inspire the delagates on how to make research work and tackle big problems like tuberculosis. He said, “Interdiscplinarism – thinking out of the box and collaborating widely is the way to go to make research research have greater impact”.
Ewan enlightened the conference on the principles of Knowledge translation and why it is important in all research settings. He highlighted ways to enhance and maximise research translation:
Mixed research teams embracing different disciplines
Include support for engagement with patients, collaborators, NGOs, policymakers and regulators
Build international connections
Aim to achieve impact, not just good science and/or technology
Translate scientific & clinical findings for external agencies
Use a variety of actions to achieve impact; a few will yield the majority of the returns
Dr. Neema Rusibamayila, Director – Preventive services represented the Permanent Secretary of the Tanzania’s Ministry of Health and in her prologue to the open discussion pledged the government’s commitment to support translation of research innovations into policy and practice. The conference ended with official launch of TWENDE project by Prof. Gibson Sammy Kibiki, Executive Secretary of the East African Health and Research Commission representing the General Secretary of the East African Community (EAC). Prof. Kibiki emphasized the EAC’s commtment to ensure that ideals of TWENDE are shared by all EAC member states and sustainability of TWENDE as a brand for translating research into policy and practice within the region.
The St Andrews Global Health group travelled to Glasgow University to meet with a delegation from the College of Medicine University of Malawi. Dr Andrew Blakie, Prof. Stephen Gillespie, Dr. Wilber Sabiiti, Prof. William Stones and Mrs Julie Struthers represented the University of St. Andrews at the meeting. Also attending the meeting were representatives from other Scottish Higher Education Institutions and the Scotland-Malawi Partnership. The Malawian delegation included:Dr Mwapatsa Mipando – Principal, Prof Victor Mwapasa – Dean of postgraduate studies & Research Mrs Longwe – College Registrar Mr Samson Kalulu – College finance officer , Dr Wilson Mandala – Associate Director Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW).
The main focus of the meeting was to identify how Scottish and Malawian colleagues could deliver future collaboration. Some of the key areas identified for development were development of clinical pathology service, Information technology to improve teaching and learning, enhanced administration for both grants and clinical-research laboratories. The main research areas identified were neglected tropical diseases, non-communicable diseases and antimicrobial resistance. The preferred model for action was to second Scottish staff to spend time on ground in Malawi to adapt teaching and technology to the situation on the ground. The meeting recommended translating these strategic areas into work packages so that Malawian partners can recruit effective partnerships with higher education institutions in Scotland to create a united programme providing mutual support.
The meeting was concluded by an informal working lunch.
Dr Wilber Sabiiti has crossed the Nile, the longest river in Africa, for TWENDE! The river roars like a lion as it descends from the stunning Karuma Falls.
Norah Owagara (CPAR Uganda Ltd) and Wilber have had a productive meeting refining the methodologies for qualitative data collection and making plans for the TWENDE launch conference, which will take place in Arusha, Tanzania on 1st of July 2016. Norah is the expert social scientist on the TWENDE project and is also in charge of organising the TWENDE consortium meetings including the launch event. The TWENDE plan for action have been finalised for all sites and Wilber is ready to hit the road again for research as soon as TWENDE is officially launched.