The 2015 WHO Global Action Plan on Antimicrobial Resistance and the 2016 UN General Assembly High-Level Meeting on Antimicrobial Resistance brought much-needed international attention and momentum to the global AMR crisis. To realize the goals these international efforts set out to achieve, a tough challenge at the country level needs to be tackled: the effective scale up and implementation of antimicrobial stewardship and surveillance policies.
My MRF-funded PhD will aim to contribute to addressing this challenge, through a systems thinking-based evaluation of the behavioural drivers of antimicrobial resistance from epidemiological and economic perspectives. Specifically, my project aims to evaluate the impact of policies aiming to optimize the behavior of patients and doctors in terms of the spread of AMR and its cost to the health sector. Later this month I will join the National Institute of Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and AMR at Imperial College, led by Prof Alison Holmes.
As I embark on my PhD journey, I had the opportunity last week to attend two research symposiums on antibiotic stewardship and infectious disease in Cochin, Kerala state, India, organized jointly by Imperial College, Amrita Hospital, and the WHO India office. The first meeting marked year one of the GCRF/ESRC-funded project ASPIRES (Antibiotic use across Surgical Pathways – Investigating, Redesigning and Evaluating Systems). The safety and efficacy of surgical procedures is threatened by growing antibiotic resistance globally, and routine operations could become excessively risky. In the US, for example, it is estimated that 39 – 51% of bacteria causing surgical site infections are already currently resistant to standard prophylactic antibiotics. AMR is a major driver of poor surgical outcomes and there is an urgent need to understand how to minimize the burden of infection and optimize antibiotic use in surgical settings. ASPIRES aims to address key drivers of AMR by developing context-relevant measures to reduce the risk of infection and optimize the use of antibiotics, coupled with tailored implementation strategies, along the entire surgical pathway.,
The second meeting, an international conference organized by Amrita Hospital, was held to coincide with Kerala’s launch of a state-level action plan for containing AMR. Kerala is the first state in India to do so, adopting a one-health approach from the outset, and developing the action plan through a collaborative exercise involving the health and environment sectors. As one of the world’s biggest consumers of antibiotics, the global importance of tackling AMR in India is critical. It is estimated that around 57,000 new-born babies in India die annually due to drug-resistant sepsis.
The meetings were a valuable opportunity to learn of the latest research developments in antimicrobial stewardship and meet and network with key researchers in this area. The key take-home messages that have stayed with me as I think about my research questions and approach are:
- What collaborative and interdisciplinary working looks like on the ground: It was evident from the meetings that ASPIRES creates an intellectual community to address the challenge of surgery, infection, and AMR across a diverse array of expertise areas including surgery, nursing, social science, anthropology, clinical pharmacy, and economics. This type of collaboration is essential to help drive the generation of useful evidence to implement effective policies at the country level.
- How to include the social science dimension in analyses, acknowledging that antibiotic use is a form of human action, and therefore socially patterned. It is important to understand the cultures driving the behaviours of antibiotic prescribing and consumption in order to address them; these include notions of responsibility, and hierarchies within health-care settings and families which can influence prescribing and consumption.
- How to roll out and sustain stewardship programmes which have been shown to improve prescribing and patient outcomes, and lower healthcare costs. While they do require an initial investment, antimicrobial stewardship programmes have been shown to be an effective way of controlling antimicrobial use, and therefore, adequate evaluations of different intervention strategies, both epidemiologically and financially, are crucial.
The meetings and visit to the AMRITA hospital facilities provided me a first-hand perspective on understanding AMR challenges on-the-ground, and have interact directly with researchers, health-care workers, and policy-makers addressing AMR in India. I would like to thank the ASPIRES team for the fantastic opportunity to attend these meetings in India which have been extremely valuable as I embark on my MRF-funded PhD, and the team at AMRITA hospital for being fantastic hosts in Cochin!
This blog article is written and submitted by Nidhee Jadeja who is a Medical Research Foundation 2018-19 core-funded PhD student at Imperial College, London.
Nidhee is studying within the ASPIRES consortium (for Antibiotic use across Surgical Pathways – Investigating , Redesigning and Evaluating Systems) and is undertaking a PhD entitled ‘Systems Thinking Based Evaluation of Patients and Doctors Behavioural Drivers of Antimicrobial Resistance’ under the supervision of Prof Alison Holmes.
Nidhee had the fantastic opportunity to attend two research symposiums on antibiotic stewardship and infectious diseases in Cochin, in Kerala state India, in October 2018. She has written an article outlining the key messages from the meetings and she thought that some of her reflections may be of interest to the other national AMR training cohort members’.