DRIVERS OF HUMAN EXPOSURE TO ANTIBACTERIAL RESISTANCE IN THE SRI LANKAN ENVIRONMENT

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There is a growing evidence-base that the presence of antibacterials, other environmental pollutants and antibacterial resistance genes in the natural environment (i.e. wastewater systems, soils, surface waters and groundwaters) is indirectly affecting human and animal health and contributing to the global antibacterial resistance problem. The release of antibacterials, other selection pressures and resistance genes to the environment will occur from a number of sources including antibacterial manufacturing sites, hospitals and clinics, livestock facilities and from households. Once in the environment these contaminants may persist or dissipate and will be distributed around the different environmental compartments. Humans and animals can then be exposed to the antibacterial compounds and resistant organisms through: the breathing of dust; consumption of contaminated drinking water, plants, meat, fish and shellfish; through recreational and bathing activities; and via contact with wildlife. The level of exposure will be driven by a range of cultural, socio-economic, health and environmental drivers. In areas of Europe and N. America with highly regulated, centralised wastewater treatment and good quality water, the environmental exposure and occurrence of antibacterial compounds and resistance genes is likely to be controlled to some degree. However, the issue of antibacterial and antibiotic resistance pollution is likely to be much more acute in rapidly developing economies and areas with lower wastewater treatment connectivity. Given the increasing evidence-base for the occurrence of antibacterials and resistance genes in the natural environment on overall resistance levels, there is an urgent need to understand the contribution of the natural environment to the problem, and the drivers behind this, in low to middle income countries (LMICs). In this project, we will bring together health practitioners, environmental scientists, microbiologists, modellers and social scientists to develop, parameterise and validate a spatial framework for modelling the occurrence of antibacterial substances and antibiotic resistance genes in the environment of Sri-Lanka and the subsequent exposure of the human populations to these. The framework will characterise the impacts of a range of drivers of occurrence and exposure including antibacterial manufacturing and use, land-use and the characteristics of the natural environment. By bringing this information together, we will be able to identify 'hotspots' of occurrence and exposure across the country which will allow future interventions to be targeted at scenarios and practices resulting in the highest risk of exposure. While in the project we will focus on the Sri Lankan situation, the knowledge, tools and processes developed in the project will be relevant to other LMICs.The 8-month development phase project will combine data and literature review activities, workshops and stakeholder events to develop a conceptual model for AMR exposure in the environment of Sri Lanka and to establish the availability of data sets to parameterise the model. This phase of the project will therefore better define the work programme of the full project phase and identify the needs of key stakeholders with an interest in the problem of antibacterial resistance in Sri Lanka. A key component of the development phase will be the establishment of an interdisciplinary and intersectoral partnership comprising leading organisations from Sri Lanka, the UK and elsewhere.