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Commonwealth Partnership for Antimicrobial Stewardship (CwPAMS)

Overview

This project is a collaboration between the NTU Makerere University Partnership with a range of multi-disciplinary collaborators in the UK and Uganda as listed above. Antimicrobial resistance (AMR) is a serious and escalating problem globally, with detrimental impacts on health and wellbeing especially in low resource regions. The purpose of this project s to reduce AMR emergence and spread by strengthening infection prevention and control (IPC) and antimicrobial stewardship (AMS) in Wakiso district, Uganda, with a focus on capacity building, stakeholder engagement, and knowledge exchange, as well as advancing education through teaching and research.

The project uses a  One Health approach which emphasises collaboration between human and animal health as well as the environment. Consequently we work with a range of collaborators to support our work... From the UK, we  work with clinical pharmacists and microbiologists at Buckinghamshire Healthcare NHS Trust, and microbiologists from NTU’s School of Science & Technology, and Animal & Rural & Environmental Studies (ARES). In Uganda, other project partners were: Uganda Pharmacists’ Association; Pharmaceutical Society of Uganda; Ministry of Water and Environment; Ministry of Agriculture, Animal Industry and Fisheries; National Drug Authority; Makerere University Department of Medical Microbiology; One Health Central and East Africa (OHCEA); Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity; Infectious Diseases Institute; Wakiso district local government; Uganda National Academy of Sciences; Uganda Medical Association; Uganda Veterinary Association; Uganda Medical and Dental Practitioners Council; National Medical Stores; Entebbe Municipal Council; and Entebbe Hospital.

Countries:

United Kingdom and Uganda

Methodological approach

Using a One Health approach, we raise awareness about AMR and train human health practitioners, community health workers, animal health workers, s, university students and primary school learners on IPC and AMS. We  collected data on antimicrobial prescribing practices at ERRH and conducted a community survey on access to and use of antimicrobials in humans and animals. So far, our partnership has trained 131 human health practitioners (including community pharmacy staff), 37 animal health practitioners and 472 CHWs on AMS/AMR/IPC; sensitised over 300 pupils from primary schools in Uganda and the UK on AMR/AMS/IPC; established two multidisciplinary online Communities of Practice for health professionals and students, with a current membership of 542 and 266 respectively. The partnership has also established a Medicine and Therapeutics Committee at ERRH; conducted 2-point prevalence surveys (PPS) of antimicrobial prescriptions at ERRH; trained 4 pharmacy interns and 4 hospital staff on PPS data collection to support the future sustainability of this intervention; mentored 5 lower-level health facilities in AMS; trained lab workers in AMR/AMS and how it relates to their diagnostic roles. In addition, 2 Ugandan pharmacists visited UK partners to learn about how AMS is implemented in the UK health system.

The CwPAMS project has improved knowledge on AMR and enhanced practices on infection prevention and antimicrobial use among human and animal health practitioners, community pharmacy staff and community health workers following the training on AMS/AMR/IPC; improved AMS at  Entebbe Regional Referral Hospital (ERRH) following establishment of a medicines and therapeutics committee and related activities; increased sharing of resources and opportunities on AMS/AMR through our established 2 online communities of practices (for both students and health practitioners); led to the development of draft AMS action plans at ERRH and 5 lower-level health facilities; GPPS training and data collection by ERRH pharmacists; and increased awareness of pupils on AMS/AMR/IPC through sensitisation sessions we conducted in schools. Our successes have been presented at various webinars including those organised by the Commonwealth Pharmacists Association; THET; the Uganda National One Health technical working quarterly meetings.

Partners and Collaborators

Funders

Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS); Fleming Fund

Partners

  • Public Health, School of Social Sciences, Nottingham Trent University, Nottingham, UK.
  • Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.

Collaborators

  • Department of Pharmacy, School of Health Sciences, College of Health Sciences, Makerere University, Uganda.
  • Buckinghamshire Healthcare NHS Trust, Aylesbury, UK.
  • Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Uganda.
  • Entebbe Regional Referral Hospital, Uganda
  • College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, Uganda.
  • School of Animal, Rural and Environmental Sciences, Nottingham Trent University, UK

Team members

  • Professor Linda Gibson, NTU-MU Partnership Lead (UK)
  • Dr David Musoke, NTU-MU Partnership Lead (Uganda)
  • Dr Jody Winter. Principal Lecturer, Microbiology, NTU
  • Claire Brandish. Lead Anti-Infectives Pharmacist, BHT
  • Kate Russell-Hobbs. Infectious Diseases Pharmacist, BHT
  • Dr. Jean O’Driscoll. Medical Microbiologist, BHT
  • Dr. Ismail Kizito. Pharmacist, ERRH
  • Florence Namukasa. Laboratory Manager, ERRH
  • Dr. Peterson Kyebambe., Hospital Director, ERRH
  • Dr. Thomas Obua., Pharmacist, Ministry of Health, Uganda
  • Dr. Bush Herbert Aguma. Pharmacist, Makerere University Department of Pharmacy
  • Dr. Lawrence Mugisha. Associate Professor in Veterinary Medicine, COVAB
  • Grace Biyinzika Lubega. Research Associate, Makerere University
  • Michael Obeng Brown. Research Associate NTU

Publications

  • Musoke D, Namata C, Lubega GB, Kitutu FE, Mugisha L, Amir S, Brandish C, Gonza J, Ikhile D, Niyongabo F, Ng BY, O'Driscoll J, Russell-Hobbs K, Winter J, Gibson L. Access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda: a qualitative study. J Pharm Policy Pract. 2021 Aug 20;14(1):69. doi: 10.1186/s40545-021-00361-4. PMID: 34416911; PMCID: PMC8379804 https://joppp.biomedcentral.com/articles/10.1186/s40545-021-00361-4
  • Musoke, D.; Kitutu, F.E.; Mugisha, L.; Amir, S.; Brandish, C.; Ikhile, D.; Kajumbula, H.; Kizito, I.M.; Lubega, G.B.; Niyongabo, F.; Ng, B.Y.; O’Driscoll, J.; Russell-Hobbs, K.; Winter, J.; Gibson, L. A One Health Approach to Strengthening Antimicrobial Stewardship in Wakiso District, Uganda. Antibiotics 2020, 9, 764. https://www.mdpi.com/2079-6382/9/11/764
  • NTU-MAK World Antimicrobial Awareness Week 2022: https://twitter.com/NTU_MAK/status/1594591141030400000?s=20&t=DH-FtZCzGb2A45PpGqFjPw