Development of two community-based interventions targeting inappropriate antibiotic dispensing and use behaviours in rural Vietnam

2000年至2010年间，全球抗生素消费量增加了35%，其中包括在其他治疗失败时作为最后手段使用的抗生素药物的大量增加。这一增长在中等收入国家尤为明显，因为这些国家人口不断增长，抗生素的使用也越来越多。抗生素消费水平的上升与抗生素耐药性的高水平以及难以或不可能用抗生素治疗的细菌感染数量的增加有关。在高收入国家，减少抗生素的不当使用已被证明可以降低人口水平的抗生素耐药性水平，但是，在传染病和抗生素耐药性负担较高的低收入和中等收入国家，很少有旨在减少抗生素使用的人口干预措施得到评估。基于干预措施，旨在减少不适当的抗生素使用和相关的抗生素耐药性。其中一项干预措施将针对通过私人药房供应抗生素，这是治疗小病的主要来源，在那里无需处方即可轻松获得抗生素。在这种情况下引入快速诊断测试将有助于药剂师区分不需要抗生素的非细菌感染患者和那些应该转诊给健康专业人员的可能细菌感染患者。另一项干预措施将解决社区对抗生素的需求，方法是利用小组参与式讨论，提高对抗生素耐药性问题的认识，并制定适当的战略，在社区解决这一问题。为了帮助制定干预措施，我们将对文献进行审查，以借鉴其他成功的方法，在正规医疗保健系统之外使用快速诊断测试，并在社区中进行健康行为改变干预。我们将从社区的抗生素供应商和消费者那里收集信息，以了解导致不适当使用的原因，我们还将探讨他们对在药店引入快速诊断测试的看法，以及什么价格对两者都有吸引力。我们将与社区成员合作，利用视觉媒体开发可用于与其他社区讨论抗生素耐药性的材料和信息。在最终确定干预措施的设计时，将开发一种方法来评估和了解这些干预措施的效果，并听取专家和当地合作伙伴的意见。将确定资金来源，以实施干预措施，并研究基于社区的干预措施对越南农村抗生素使用和耐药性的影响。我们将通过国际同行评审的出版物、简报文件以及与当地合作伙伴和社区参与者的讨论，传播我们从这一过程中学到的知识。

Between 2000 and 2010, worldwide antibiotic consumption increased by 35%, including large rises in the use of antibiotic drugs used as a last-resort, when other treatments fail. This rise was particularly apparent in middle income countries, with growing populations and increasing access to antibiotics. Rising levels of antibiotic consumption are associated high levels of antibiotic resistance, and increasing numbers of bacterial infections that are difficult or impossible to treat with antibiotics. Reducing inappropriate antibiotic use has been shown to reduce the level of antibiotic resistance at population-level in high income countries, but few population-level interventions aiming to reduce antibiotic use have been evaluated in low and middle income countries with higher burdens of infectious disease and antibiotic resistance.This development grant will inform the design of two community-based interventions aiming to reduce inappropriate antibiotic use and related antibiotic resistance. One intervention will target the supply of antibiotics through private pharmacies, the major source of treatment for minor illness, and where antibiotics can easily be obtained without a prescription. Introducing a rapid diagnostic test in this setting would help pharmacists to differentiate between people with non-bacterial infections that do not require antibiotics, and those with likely bacterial infections that should be referred to a health professional. The other intervention will tackle the demand for antibiotics in communities by using participatory discussion in groups to improve understanding of the problem of antibiotic resistance, and develop appropriate strategies to address it in their community. To assist intervention development, we will conduct a review of the literature to learn from other successful approaches using rapid diagnostic tests outside the formal healthcare system, and health behaviour change interventions in communities. We will collect information from providers and consumers of antibiotics in communities, to understand what drives inappropriate use, and we will also explore their views about the introduction of rapid diagnostic tests in pharmacies, and what price would be attractive for both. We will work with community members, using visual media to develop materials and messages that can be used to talk about antibiotic resistance with other communities.On finalising the design of the interventions, a methodology will be developed to evaluate and understand the effect of these interventions, with input from experts and local partners. Funding sources will be identified to implement the interventions and research the effect of community-based interventions on antibiotic use and resistance in rural Vietnam. We will disseminate our learning from this process through international peer reviewed publications, briefing papers, and discussions with local partners and community participants.