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Shared Learning 2023 – Multi County Collaboration

Organisation

Nottingham Trent University and Makerere University

Scaling-up interventions for strengthening antimicrobial stewardship using a One Health approach in Wakiso district, Uganda

Project Overview

The partnership between Nottingham Trent University, Makerere University, Buckinghamshire NHS Health Trust (BHT), and Entebbe Regional Referral Hospital (ERRH) has been promoting Antimicrobial Stewardship (AMS) in Wakiso District since 2019. Other key stakeholders involved in this project include Wakiso district local government, Ministry of Health, other policy makers, media, health practitioners, local leaders, and various professionals ranging from pharmacists, microbiologists, environmental health scientists, and animal health experts.

Our most recent funding under the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) 1.5, an initiative of Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET) under the Fleming Fund of the UK Department of Health and Social Care (DHSC), was aimed at scaling-up AMS interventions in Wakiso district. This phase of the project had several activities mainly at ERRH including training of 8 pharmacy staff on conducting Global point Prevalence Survey (GPPS); collecting GPPS data; carrying out an AMS workshop for 24 members of the medicines and therapeutics committee (MTC); holding a workshop for 25 laboratory staff and clinicians on AMS / Antimicrobial Resistance (AMR); developing an AMS plan; providing mentorship support on AMS to five lower-level health facilities; training 53 health practitioners (community pharmacy staff, other human health and animal health practitioners) and 151 community health workers (CHWs) on AMS / AMR/ Infection Prevention and Control (IPC); and increasing membership /continuing to engage members of the earlier established Communities of Practice (COPs) on AMS for health professionals and students which grew to over 540 and 250 respectively.

Both the Uganda and UK teams were involved in co-designing and implementing the interventions. The UK team also supported ERRH remotely in drafting the hospital’s AMS Action Plan through online platforms such as Zoom for meetings and email for review of documents.

Impact on tackling AMR

“Our partnership was invited and shared project findings during a National One Health technical working group (OHTWG) quarterly meeting on 23rd March 2022. We were also able to contribute to the Education and Awareness Survey in the WHO African Region to inform Regional Education and Awareness Implementation from 2017-2021. During the Global Point Prevalence Survey (GPPS) at ERRH, we trained 4 pharmacy interns in addition to the 4-hospital staff on GPPS data collection which will contribute to sustainability of interventions. In addition, the 4-hospital staff attended an online GPPS training by the University of Antwerp which made the in person training more engaging.

Below is an evaluation quote following the AMS mentorship sessions of a lower-level health facility:
The interventions suggested during the mentorship have been feasible. Among which was the creation of an AMS committee. We have also been guided about how we can stop antimicrobial resistance. Before we did not know how to talk to patients but now with the different education materials we have, it is easier. We now have posters that spread awareness and platforms from which we get information about AMS. We are very thankful for this mentorship by Entebbe Regional Referral Hospital” Health Officer in-charge of a lower-level health facility, Wakiso District

Overall, a total of approximately 1000 community members where indirectly reached and educated about AMS, this follows an evaluation of the health workers who participated in the different AMS activities which we conducted. Most of our post-training assessments during our trainings and workshops showed that over 97% participants had gained knowledge on AMR and AMS. We believe that the human and animal health workers trained, as well as communities reached during the project are change agents in their respective settings regarding proper access and use of antimicrobials.

Future Development

We hope to scale-up the project activities to other parts of Wakiso district and country therefore reaching out and educating more health workers and communities about antimicrobial stewardship (AMS). In addition, we hope to educate more animal health practitioners on AMS in order to strengthen the One Health approach of tackling antimicrobial resistance. As a way of ensuring adaptation of the AMS interventions we also plan on including behavioural specialists on the project team in order to make sure that the AMS interventions implemented are sustained at the facilities in the community. With the many AMS interventions done at the different health facilities, we hope to carry out further project dissemination to the communities, health workers and other local, national and international stakeholders. Lastly, in order to achieve our future ambitions, we shall continue seeking for more funding to carry out more AMS interventions in Wakiso district and beyond.

Organisation

Tropical Health and Education Trust (THET)

Development and user feedback on Antimicrobial Stewardship Explainer Videos: a collaborative approach between the UK and eight African countries

Project Overview

THET and CPA, with funding from the Fleming Fund and input from more than 50 colleagues across the UK and eight African countries, developed four AMS Explainer Animation videos with the animation company, Video Symmetry. The videos represent different situations, stories, and information to help explain AMS in easy-to-understand ways. The videos are designed for both for the public and health practitioners and topics include:

  • The patient and doctor experience with antimicrobials – Explores parents’ experience with seeking medical help for their child, and preventative actions one can take to reduce the chances of AMR.
  • Continuum of care – Explores the different roles involved in the whole journey of care.
  • Surgical prophylaxis – Explores the journey for healthcare professionals for managing surgical site infections, using the WHO Surgical Safety Checklist.
  • What is AMR and AMS? (In final stages of development) – Explores what AMR and AMS are and why it is important that we tackle it.

Key stakeholders were engaged from a range of backgrounds and experience, including healthcare informants, external advisers (e.g., Africa CDC and WHO). A stakeholder workshop concluded that English was the most useful language for the videos but recorded in different accents so the characters could be relatable in multiple contexts. Scripts were developed through several reviewing sessions. Draft storyboard animations were shared with the reviewers for further feedback.

Several review phases were necessary to ensure the videos are both technically and contextually accurate and appropriate. The main challenge has been to make the complexity of AMS/AMR easily understandable to a wide audience.

Following the completion of priority edits, three of the four videos were uploaded to YouTube and shared with the Health Partnerships to pilot during training in May 2022. A feedback survey was shared to inform use, value, and next steps for the videos.

Impact on tackling AMR

The videos have been promoted via the Commonwealth Partnerships for Antimicrobial Stewardship Scheme (CwPAMS) and have been used in AMS/AMR training events across several African countries including Malawi, Sierra Leone and Uganda.

1. Use of the videos so far includes:
○ Training workshops involving 50+ and 145+ people
○ During seminars of 20+ people and during AMS team meetings
○ One partnership bought a TV to show the videos to hospital staff/students in the clinical skills training room at the hospital. This room is used for small group teaching and played to multiple groups in the future
○ One partnership showcased the videos during training, and trainees then translated the videos into Swahili for future use.
○ One example video was showcased during the CwPAMS Final Programme Event (to over 160 people), receiving positive feedback from participants

2. Feedback has been very positive. From the 52 respondents that have provided feedback (from Nigeria, Ghana, Uganda, Tanzania, the UK) in the survey, results have shown:

94% of respondents gave the videos either a ‘5’ or ‘4’ for usefulness, 5 being ‘very useful’

For ways that respondents have used/would use the videos, respondents stated:
o 81% would share with professional groups
o 71% would use for training at schools and universities
o 64% would show the videos at hospital/clinic waiting rooms or staff rooms
o 56% would use in training and workshop for health regulatory bodies

The videos which were most useful for learning:
o 47% of respondents stated they learned most from the patient experience video
o 37% of respondents learned most from continuum of care
o 16% of respondents learned most from surgical prophylaxis

3. Quotes include: “These are PERFECT for Public Health Promotion programmes”; “Very strong videos – useful for a range of training situations”.

Future Development

We plan to do the following activities:

  • Finalise the fourth video (What is AMS/AMR?) and make accessible on YouTube.
  • Continue to gather feedback from Health Partnerships and, if feasible, make priority edits to the videos where suggestions were made in the survey. For example, adding more languages and/or subtitles with more local languages, so they can be more accessible in more contexts.
  • Disseminate the videos during the next phase of the CwPAMS Programme (2022-25), which will be to an even wider audience. Through this programme, we will encourage Health Partnerships to use the videos in training and at the hospital/clinics. We will continue to ask HPS to report on how they were used so we can continue to support dissemination.
  • Support Health Partnerships to disseminate the videos more widely. Partnerships have expressed interest in sharing the videos on, for example, TV/Radio shows, social media, and through printed screen shots of the videos on posters.
  • Share the videos with wider stakeholders, for example, the Africa CDC, Fleming Fund, and WHO.

Nottingham Trent University and Makerere University

Tropical Health and Education Trust (THET)