Optimising community antibiotic use and infection control with behavioural interventions in rural Burkina Faso and DR Congo

抗生素耐药性(AMR)的出现是低收入和中等收入国家的一个严重关切。抗生素的不受管制使用是AMR的主要驱动力，在LMIC中非常普遍，药店是主要供应商。一个健康隔间之间的物理相互作用增加了跨域传播风险，尽管不同储存库的相对重要性尚不确定，而且LMIC中AMR的社区一级动态基本上无法量化。我们将开发和评估针对药店及其社区的行为干预捆绑包，以优化抗生素使用和改善卫生，从而减少AMR的流行和传播。在为期6个月的当地共同发展阶段之后，干预措施将在布基纳法索和刚果民主共和国已建立的具有临床微生物学设施的健康人口监测点实施12个月，并在分组随机对照研究中进行评估，比较干预村庄和对照村庄。主要结果衡量标准是药店(不需要正式处方)Watch抗生素供应的变化，通过患者离职访谈和模拟客户访问进行评估。卫生做法和AMR病原体和基因携带的变化将在重复的人口调查中进行评估。啮齿动物生活在撒哈拉以南非洲的大部分地区，与人类非常接近，它们提供了环境AMR病原体和基因暴露的代理估计。通过对选定的人类和啮齿动物分离株进行建模和测序，我们将量化抗生素使用和卫生做法的变化如何影响AMR传播。

Emergence of antibiotic resistance (AMR) is a serious concern for Low and Middle Income Countries (LMICs). Unregulated use of antibiotics, a major AMR driver, is highly prevalent in LMICs, with medicine stores as key providers. Physical interactions between One Health compartments increase cross-domain transmission risks, although the relative importance of different reservoirs is uncertain, with community- level dynamics of AMR in LMICs largely unquantified. We will develop and evaluate a behavioural intervention bundle, targeting medicine stores and their communities, to optimise antibiotic use and improve hygiene, and hence reduce AMR prevalence and transmission. After a 6-month local co-development phase, the intervention will be implemented over 12 months in established health demographic surveillance sites in Burkina Faso and DR Congo with clinical microbiology facilities, and evaluated in a cluster RCT, comparing intervention and control villages. The primary outcome measure is the change in Watch antibiotic provision from medicine stores (where a formal prescription is not required), assessed via patient exit interviews and simulated client visits. Changes in hygiene practices and AMR pathogen and gene carriage will be assessed in repeated population surveys. Rodents, living in close proximity to humans in much of sub-Sahara Africa, provide a proxy estimate of environmental AMR pathogen and gene exposure. Using modelling and sequencing of selected human and rodent isolates, we will quantify how changes in antibiotic use and hygiene practices impact AMR transmission.