The Antimicrobial agents’ usage, antimicrobial resistance and policy symposium

 

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:

  1. The Global action plan on AMR: what implementation lessons can be drawn by the EAC?
  2. Situation analysis of the use or misuse of antimicrobial agents in EAC in relation to the rest of Africa.
  3. The magnitude, transmission dynamics, and drivers (biological, health system, socio-economic etc) of antimicrobial resistance in EAC.
  4. The human – animal (and agricultural) interface impact on the use of antimicrobial agents and spread of antimicrobial resistance.
  5. Do EAC member states have policy and regulatory framework on the use of antimicrobial agents – to what extent are these policies being practiced?
  6. To what extent is research evidence being used in formulating policy on use of antimicrobial agents?
  7. Situational analysis of the capacity (laboratory, clinical, community health etc) of health systems among EAC states to prevent or manage antimicrobial resistance
  8. 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.

Getting innovative diagnostic and treatment tools into policy and practice

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.

Wilber with the Rwanda team