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（LMICs）严重关切的问题。抗生素的无管制使用是抗生素耐药性的一个主要驱动因素，在中低收入国家非常普遍，药店是主要提供者。尽管不同水库的相对重要性尚不确定，但One Health各分区之间的物理相互作用增加了跨域传播风险，低收入和中等收入国家AMR的社区水平动态在很大程度上未被量化。我们将制定和评估一套行为干预措施，以药店及其社区为目标，优化抗生素使用和改善卫生，从而减少抗生素耐药性的流行和传播。在6个月的地方共同开发阶段之后，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卫生人口监测点实施12个月，并通过聚集性随机对照试验进行评估，比较干预村和对照村。主要结果衡量指标是药店（不需要正式处方）抗生素供应的变化，通过患者出院面谈和模拟客户访问进行评估。将在重复的人群调查中评估卫生习惯和抗菌素耐药性病原体和基因携带的变化。在撒哈拉以南非洲的大部分地区，啮齿动物与人类生活得很近，它们提供了环境抗菌素耐药性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习惯的变化如何影响AMR的传播。

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.