Supporting the National Action Plan on AMR in Tanzania (SNAP-AMR)

支持坦桑尼亚抗微生物药物耐药性国家行动计划 (SNAP-AMR)

• 批准号: MR/R015066/1
• 负责人: Ruth Zadoks
• 金额: $ 10.22万
• 依托单位: University of Glasgow
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR015066%2F1
• 关键词: Supporting; National; Action; Plan; AMR

Antimicrobial resistance (AMR) is recognised as a global threat to human and animal health, productivity and prosperity. AMR is widespread in both resource-rich nations such as the UK and in low and middle income countries (LMICs). The United Republic of Tanzania is one such LMIC, and in response to a call to action from the World Health Organisation, it has created a National Action Plan (NAP) to combat AMR. The NAP is an ambitious plan outlining five strategic routes for tackling AMR: i) improved awareness and understanding; ii) enhanced surveillance and research; iii) better sanitation, hygiene and infection prevention; iv) optimized use of antibiotics; and v) sustainable investment in alternatives. In common with many LMICs, the challenge posed by AMR is exacerbated by widespread or unregulated use in both humans and livestock, whilst successful implementation of the NAP is threatened by lack of human and financial resources. Prioritisation of activities and targeting of interventions is therefore an essential component of an effective and efficient campaign to control AMR.Our research will provide new evidence to support this prioritisation and targeting, taking an approach that recognises that behavioural change is a complex phenomenon depending not just on policy, regulation or knowledge provision but also on cultural background and social norms. Our team of UK and Tanzania-based researchers and policy experts will take an interdisciplinary approach to provide novel insights into the biological, social and cultural drivers influencing antibiotic use in the community and health care system; the spread of AMR between the humans and animals in the community and health care settings; knowledge about AMR; and how to change behaviours to reduce antibiotic use and the spread AMR.We will contrast doctor prescribing practices in different health care settings (referral hospitals, district hospitals, health centres, dispensaries), as well as investigating community access and attitudes to antibiotics among householders, community 'drug' shops and unregulated sources such as roadside traders. We will use focus groups to examine factors that influence prescribing and usage, e.g. availability of antibiotic drugs, diagnostic facilities, patient demands, medical training and knowledge, coupled with choice-based experiments to establish how best to create change in prescribing behaviour or use. We will also use choice-based experiments to examine use in livestock by individuals with different levels of knowledge about AMR, e.g. district vets, community livestock officers and livestock holders. In parallel, bacterial isolates from people or livestock in hospital and community settings will be DNA-sequenced and examined used genomic tools to establish whether resistant commensal bacteria found in faecal samples in the community are those responsible for illness (respiratory infections, diarrhoea, sepsis and urinary tract infections) in hospitalised children.The final component will be to assess the knowledge and sources of knowledge held by the public, health care and veterinary workers, policy makers and educators; to design interlinked targeted media campaigns that reflect educational, professional and cultural differences; and to assess the uptake of these materials and their impact on attitudes and approaches to antibiotic drugs and resistance.The outcomes of our research will help priority setting and targeting in the NAP by identifying the settings (health care system or community) where most effective change can be achieved; showing how to create change in antibiotic usage (e.g. via improved training or education, diagnostic facilities or a social-norm based 'nudge') and identifying the individuals to target to create the most effective change; and by designing and delivering a mass media campaign to create awareness and behavioural change that will help Tanzania to combat the threat posed to its future by AMR.

抗菌素耐药性（AMR）被认为是对人类和动物健康、生产力和繁荣的全球威胁。AMR在英国等资源丰富的国家和中低收入国家（LMIC）都很普遍。坦桑尼亚联合共和国就是这样的LMIC之一，为了响应世界卫生组织的行动呼吁，它制定了一项国家行动计划（NAP）来对抗抗生素耐药性。国家行动计划是一项雄心勃勃的计划，概述了应对抗生素耐药性的五条战略路线：i）提高认识和理解; ii）加强监测和研究; iii）改善环境卫生、个人卫生和预防感染; iv）优化抗生素的使用; v）对替代品的可持续投资。与许多低收入国家一样，由于在人类和牲畜中广泛或不受管制地使用抗生素耐药性，抗生素耐药性所带来的挑战更加严峻，而国家行动方案的成功实施则受到缺乏人力和财力资源的威胁。因此，确定活动的优先顺序和干预措施的目标是有效和高效控制AMR运动的重要组成部分。我们的研究将提供新的证据来支持这种优先顺序和目标，采取的方法认识到行为改变是一种复杂的现象，不仅取决于政策，法规或知识提供，还取决于文化背景和社会规范。我们的英国和坦桑尼亚的研究人员和政策专家团队将采取跨学科的方法，为影响社区和医疗保健系统中抗生素使用的生物，社会和文化驱动因素提供新的见解; AMR在社区和医疗保健环境中的人类和动物之间的传播;关于AMR的知识;以及如何改变行为以减少抗生素的使用和AMR的传播。我们将对比不同医疗机构的医生处方实践（转诊医院、地区医院、保健中心、药房），以及调查社区获得抗生素的情况和住户对抗生素的态度，社区“毒品”商店和路边商贩等不受管制的来源。我们将使用焦点小组来检查影响处方和使用的因素，例如抗生素药物的可用性，诊断设施，患者需求，医疗培训和知识，再加上基于选择的实验，以确定如何最好地改变处方行为或使用。我们还将使用基于选择的实验来检查具有不同AMR知识水平的个人在牲畜中的使用情况，例如地区兽医，社区牲畜官员和牲畜饲养者。与此同时，将对医院和社区环境中的人或牲畜的细菌分离物进行DNA测序，并使用基因组工具进行检查，以确定社区粪便样本中发现的耐药细菌是否是导致疾病的细菌（呼吸道感染、腹泻、败血症和尿路感染）。最后一部分将是评估公众的知识和知识来源，卫生保健和兽医工作者、决策者和教育工作者;设计相互关联、有针对性的媒体宣传活动，反映教育、专业和文化差异;并评估这些材料的吸收及其对抗生素药物和耐药性的态度和方法的影响。我们的研究结果将有助于通过确定环境，（卫生保健系统或社区）可以实现最有效的改变;显示如何改变抗生素的使用（例如，通过改进培训或教育、诊断设施或基于社会规范的“助推”），并确定目标个人，以创造最有效的变革;并通过设计和开展大众媒体活动来提高认识和改变行为，这将帮助坦桑尼亚应对抗生素耐药性对其未来构成的威胁。