One Health Drivers of Antibacterial Resistance in Thailand

与许多海外发展援助国家一样，特别是南亚和东南亚的国家，泰国的健康和福祉受到在人类、动物和环境中发现的致病细菌中抗菌素耐药性(ABR)的高流行率的严重破坏。ABR降低了医生使用抗生素和其他抗菌药物治疗感染的能力，估计2010年对泰国的影响为3.8万人死亡，经济损失12亿美元。ABR率继续上升，其影响也在平行上升。由于ABR的威胁，泰国发起了《泰国抗菌素耐药性国家战略计划(2017-2022)》。这将包括改善对ABR细菌的国家监测，以量化问题，采取行动降低感染率，并减少抗生素和其他抗菌药物的使用，众所周知，这些药物是ABR细菌的选择。然而，即使这一战略计划开始产生效果，泰国和其他官方发展援助国家仍有许多关于ABR的知识需要了解，发达国家也是如此，这些国家的ABR减少战略已经实施了一段时间。在这个发展项目中，我们将建立在英国和泰国临床医生和学者之间已经启动的合作伙伴关系上。我们将开发一个财团赠款申请，以解决泰国关于ABR的知识差距，这是我们通过英国和泰国合作伙伴之间的讨论确定的。该联盟将考虑环境中的化学物质--自然存在的或由于农业污染(例如使用除草剂)而存在的--是否可以选择ABR细菌。这将使减少抗生素使用的策略在减少ABR方面不那么有效，因为在一个环境中化学污染很常见的社区。我们还将考虑ABR细菌是否在泰国农村的当地环境中传播，并将测量随着泰国国家抗菌素耐药性战略计划的进展，这种情况如何随着时间的推移而变化。我们将进行研究，旨在了解农民使用抗生素、农场管理做法以及人们如何在医疗保健方面做出决定的关键行为。我们将使用我们从微生物学、基因组和化学筛查以及人类学研究中产生的信息来产生数学模型，这些模型可以用来预测可以做出的有用变化，以减少泰国和其他官方发展援助国家的ABR。我们还将帮助泰国政策制定者评估通过泰国国家战略计划发起的改革的有效性。最后，我们将开发将用于简化我们的研究的技术；这些技术也可能有助于帮助当地社区解决ABR问题。在开发项目期间，我们将在泰国举办一系列研讨会，这些研讨会将用于制定我们提议的研究项目的细节，并确定我们将使用的研究地点。这些研讨会还将使我们有机会在泰国和英国的ABR专家之间分享知识，并将一群早期职业学者聚集在一起，以提高关于ABR在泰国的知识库。我们还将讨论研究生教育战略，以及泰国的公众参与活动。开发阶段还将对泰国ABR的决策进行全面调查，使我们能够根据这些群体和个人的需求和知识差距来定制我们的财团研究项目

Like many Overseas Development Assistance (ODA) countries, and particularly those in South and South East Asia, Health and well-being in Thailand is significantly undermined by the high prevalence of antibacterial drug resistance (ABR) in disease-causing bacteria found in humans, animals and the environment. ABR reduces the ability of doctors to treat infections with antibiotics and other antibacterial drugs, with an estimated impact on Thailand in 2010 of38,000 deaths and an economic loss of 1.2 billion US$. ABR rates continue to rise and its impact is rising in parallel.Because of the threat of ABR, the Thai National Strategic Plan on Antimicrobial Resistance (2017-2022) has been instigated. This will involve improved national surveillance for ABR bacteria to quantify the problem, initiatives to reduce the rates of infections and those to reduce the usage of antibiotics and other antibacterial drugs, which are known to select for ABR bacteria. However, even when this strategic plan starts to pay dividends, there will be much still to learn about ABR in Thailand, and in other ODA countries, as is also true for developed countries where ABR reduction strategies have been in place for some time.In this development project, we will build on partnerships we have already initiated between UK and Thai clinicians and academics. We will develop a consortium grant application to address knowledge gaps about ABR in Thailand, which we have identified through discussions between UK and Thai partners. The consortium will consider whether chemicals in the environment - present naturally or as a result of agricultural pollution (e.g. herbicide use) - can select for ABR bacteria. This would render strategies to reduce antibiotic use less effective in reducing ABR in a community where chemical pollution of the environment is common. We will also consider whether ABR bacteria circulate within local environments in rural Thailand, and will measure how this changes over time as the Thai National Strategic Plan on Antimicrobial Resistance progresses. We will perform research aimed at understanding key behaviours around antibiotic use by farmers, farm management practices, and how people make decisions around healthcare. We will use the information that we generate from the microbiology, genomic and chemical screens and the anthropological research to produce mathematical models that can be used to predict useful changes that can be made to reduce ABR in Thailand and other ODA countries. We will also help Thai policymakers evaluate the effectiveness of changes initiated through the Thai National Strategic Plan. Finally, we will develop technologies that will be used to streamline our research; technologies that may also be useful to help local communities tackle the problem of ABR.During the development project we will run a series of workshops in Thailand, which will be used to develop the details of our proposed research project and to identify the study sites we will use. These workshops will also give us the opportunity to share knowledge amongst Thai and UK ABR experts, and bring together a group of early career academics, to raise the knowledge base around ABR in Thailand. We will also discuss postgraduate education strategies, and public engagement events in Thailand. The development phase will also involve a comprehensive investigation of policymaking around ABR in Thailand, enabling us to tailor our consortium research project to the needs and knowledge gaps of these groups and individuals