University of Salford

Provide a brief overview of your project?
As a member of a national steering group working with Public Health England we collaborated to produce an activity pack and badge -‘The Antibiotic Guardian Youth Badge’. I went on to pilot the badge locally with my local Cub Scout Group.

The aim of the activities were to help children to learn, in an age and ability appropriate way, that is fun and engaging, about and to take action on this major health issue of antimicrobial resistance. By helping them understand the importance of reducing the spread of infection, children may gain an understanding of looking after the health of themselves and others and in becoming Antibiotic Guardians they can grow up with the knowledge and motivation to protect our antibiotics!

This issue is not just for the UK and so my involvement in the Commonwealth Partnerships for Antimicrobial Stewardship Scheme (THET Partnership for Global Health) was an ideal opportunity for me to pilot this activity pack in Uganda, to determine if the resource and its activities were transferable and translatable to children in this country and determine if the activity pack was an effective tool for sharing the importance of AMR in Uganda.

Two schools in Uganda took part in the pilot, with a total of 89 children taught, along with 21 teachers and teaching assistants, clinician, volunteers and university students affording me the opportunity to apply a ‘training of trainer’ model to the activity badge and ensuring sustainability of this teaching.

Children in Uganda reported high enjoyment and this pilot suggests that children are consolidating messages and improving intentions for correct behaviours, particularly around hand and respiratory hygiene, just the same as was demonstrated by the work in UK.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
100% of children completing the evaluation enjoyed all or most of the session, with 86% of children stating they learnt lots of new things (including “personal hygiene”, “hand washing”, “washing with soap”, “how to prevent the spread of infection”, sneezing into a tissue”, “types of microbes”). 86% children pledging to go home and tell their families everything they learnt! 95% children said they would wash their hands with soap whilst 91% said they would catch their sneezes in a tissue and 95% stated that following on from the session they would only take antibiotics when they really needed them!

Overall children in Uganda reported high enjoyment and this pilot suggests that children are consolidating messages and improving intentions for correct behaviours, particularly around hand and respiratory hygiene, just the same as was demonstrated by the work in UK.
How is the project to be developed in the future?

The activity pack is available for continued use and the equipment used to support the activities was left as a ‘kit’ for continued use in Uganda. Because a ‘training of trainer’ model approach to teaching sessions was applied it should ensure that the 21 teachers and teaching assistants, clinician, volunteers and university students still in Uganda can support the sustainability of this approach by continuing to deliver further sessions and in turn also apply ‘training of trainer’ model approach. The activity pack can be used by any leader – you do not need to have background knowledge on the topic to use the pack and the flexibility of the activities in the pack means leaders can pick and choose activities suitable for the age and ability of their group.

To further the collaboration between the children in both countries, the UK children wrote letters to and drew pictures for the children in Uganda telling them all about themselves and why they felt the badge work was important and what they enjoyed the most. It is hoped that the Ugandan children will write back and a continued dialogue built on the importance of AMR can grow between the groups of children in the UK and Uganda.

University College London Hospitals NHS Foundation Trust in partnership with University of Health and Allied Sciences and Ho Teaching Hospital

Provide a brief overview of your project?
Antimicrobial resistance (AMR) has become a serious concern in public health today. Global mortality projections suggest greatest impact will be seen in parts of Africa and Asia if left unchecked. There is therefore a need to implement effective antimicrobial stewardship (AMS) programmes in these settings to slow down the increasing threat of AMR and preserve the effectiveness of standard antimicrobial therapies.

Our project is a partnership between the University College London Hospitals NHS Foundation Trust) and Ho teaching hospital with the University of Health and Allied Sciences in Ghana, and one of the 12 partnerships awarded by the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) scheme funded by the UK Department of Health and Social Care’s Fleming Fund. We aimed to leverage the expertise of UK health institutions and technical experts to strengthen the national health workforce in African partner institutions to address antimicrobial resistance (AMR) challenges. This will build capacity in AMR surveillance locally, nationally and globally and to implement systems for evidence based antimicrobial use.

The focus of our partnership was to enhance pharmacists’ roles to support the delivery of antimicrobial stewardship programmes in the Ho teaching hospital.
We identified the priorities for implementing AMS in our partner hospital through an initial scoping assessment at the project inception. The main activities of our project included training sessions on AMR/AMS and IPC for all healthcare professionals and assessing current antimicrobial use practices and prescribing patterns through the Global Point Prevalence Survey (GPPS). We employed a train-the trainer model incorporating established behaviour change and quality improvement models. We surveyed antimicrobial use practices at two different time points using the GPPS methodology, generating data needed to inform local policies and identify areas for improvement within our partner hospital.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

1. Increased knowledge of trained multidisciplinary group in AMS & infection prevention and control (IPC): The UK team developed and delivered AMR/AMS focused training sessions for doctors, nurses, pharmacists and laboratory staff in Ghana during the first visit. The local Ghana team was also supported to deliver multidisciplinary training session on infection prevention and control (IPC) measures. Pre and post training surveys demonstrated an increase in AMS/AMR knowledge and awareness among healthcare providers. This led to a cascade AMS training session for surgeons and staff in other units within Ho teaching hospital led by one of the attendees. Additionally, one of the team members was interviewed on a regional satellite TV, which raised AMR awareness to a wider community in the local setting.
2. Data generation and surveillance of hospital antibiotic use through GPPS: prior to the project set-up, there was no practice of antimicrobial use documentation/surveillance. We were able to utilise the sessions to train attendees on the GPPS tools and methods and conducted the PPS at two different time points. This led to increased engagement and awareness amongst Ho Teaching Hospital staff and availability of local antimicrobial use data, demonstrating the trend and relevant prescribing patterns for informing local policies.
3. Set up of hospital AMS team and development of draft AMS policy: representatives from different departments and units were selected by the hospital management to constitute the local AMS team to champion and drive stewardship activities. The first draft of an overarching hospital-wide antimicrobial policy was developed by the partnership team, awaiting review and endorsement by Ho Teaching Hospital committee.

How is the project to be developed in the future?
While the project awarded is for a 12month duration, we have established a life-long partnership/collaboration between both institutions, actively sourcing funds to build on existing structures to maximise health outcomes in the local practice settings. Future objectives will be to evaluate the impact of the AMS team and policy development and identifying further opportunities for improvement to practice. Ghana team visits to the UK NHS are proposed to gain hands-on experience in various hospital-care practices that can be adapted and implemented locally.

Makerere University School of Public Health

Provide a brief overview of your project?
Buckinghamshire Healthcare NHS Trust (BHT), UK and Nottingham Trent University NTU, UK in partnership with Makerere University School of Public Health (MakSPH), Makerere University Pharmacy Department (MakPD), Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Entebbe Regional Referral Hospital, Wakiso District Local Government, and Ministry of Health recently completed a multidisciplinary project on Strengthening Antimicrobial Stewardship (AMS) in Wakiso district, Uganda with a focus on capacity building, stakeholder engagement, and knowledge exchange using a One Health approach. This project was funded by the Commonwealth Partnerships for Antimicrobial Stewardship Scheme (CwPAMS), 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). The main achievements of the project were: 1). Completion of the first Global Point Prevalence Survey (G-PPS) and establishment of a Medicines and Therapeutic Committee at Entebbe hospital; 2). Completion of a One Health community survey on AMS among 420 households in Wakiso District; 3). Trained 86 human and animal health practitioners and 227 community health workers on AMR and AMS; and 4). Establishment of an online community of practice (COP) on AMS in Uganda.

Other partners that were involved in the project included Ministry of Agriculture, Animal Industry and Fisheries; Makerere University Department of Medical Microbiology; One Health Central and East Africa (OHCEA); and Entebbe Municipal Council. Other key stakeholders that were involved in the project included policy makers, researchers, media, health practitioners, local leaders, community health workers, and members of the community.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
Both the UK and Uganda team co developed AMS / AMR training materials and were involved in the training. The UK trainers included 3 clinical pharmacists, 2 microbiologists, and an animal health practitioner, while the Uganda team included 3 pharmacists, a veterinary doctor and 2 environmental health scientists. 80% of the health practitioners and 97% of the CHWs reported increased knowledge immediately after the training. Participants were empowered to make changes to their practice, and they were able to make AMS “pledges” at the end of the training workshops.

In addition, the UK team delivered 3 workshops and seminars attended by over 120 Makerere University students on AMS as practiced in the UK, and two Ugandan Pharmacists shared the Ugandan experience of AMS at BHT and NTU in the UK.
The project has also set up two online communities of Practice (COPs) on AMS for health practitioners and students. Through these COPs, both the UK and Uganda teams have provided resources on AMR and AMS to various practitioners in human, animal and environment sectors. As a result, members on the platform receive updates on AMR / AMS to guide them during their practice. Shared resources on the CoPs so far include: webinars, online courses, conferences, published articles, and job opportunities.

The results from G-PPS are to be used to promote better antimicrobial stewardship practices at Entebbe hospital. The findings of the community survey on access to and use of antimicrobials, and our assessment of healthcare worker knowledge, practices and attitudes to AMS are being used to improve practice and policy on AMS/AMR in Uganda as part of the implementation of the AMR National Action Plan (NAP) following dissemination of their dissemination to various stakeholders in Uganda including the Ministry of Health.
How is the project to be developed in the future?
The project team members are looking out for other avenues to support future collaborations between the UK and Uganda so as to continue partnership activities. Results from the community one health survey and healthcare worker assessment will be used as a baseline to apply for more funding for further partnership work to promote AMS/AMR in the UK and Uganda. We intend to adapt the training materials that were used with health practitioners, and use them with university students in the College of Health Sciences at Makerere University, Uganda so that students are aware of the importance of AMR and AMS before they graduate & begin working in healthcare professions. We also intend to continue with annual G-PPS at Entebbe hospital to monitor antibiotic prescribing, and we intend to continue promoting AMS via the online COP.

Norfolk and Suffolk NHS Foundation Trust

Provide a brief overview of your project?
Introduce the principles of antimicrobial stewardship and infection control to staff at the AGHS and develop a community education programme to increase awareness around antimicrobial resistance within the local population.
Hold community Durbars to educate public radio stations
Community Durbars within the area with a focus on public health messages around antimicrobial use
Four radio shows focussing on different topics around antimicrobial use with opportunity for listeners to ask questions
Utilised local healthcare staff for translation, enabling them to continue to spread message beyond the lifetime of the project.
Sharing information within the hospital
Observation of infection control practices within AGHS
Training sessions held at the AGHS
Post training assessment and feedback
Share training material with AGHS to enable a train the trainer approach
Engage with licensed drug sellers within Saboba
Facilitated first meeting between licensed drug sellers and representatives at AGHS
Discussed challenges and issues within the area
Raise awareness of availability of antimicrobials from unlicensed drug sellers
Engage with local organisations and discussion within clinical meetings
Met with key people within the local organisations to raise the profile of antimicrobial resistance and the partnership activities
Antimicrobial resistance became a regular item on agenda of clinical meetings
Behaviour change training
Psychologists with the Change Exchange delivered training on behaviour change
Discussion on the potential and application within the AGHS
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
Charts
Charts to be developed to guide newer prescribers on the use of antimicrobials
To include advice on appropriate antimicrobial in specific conditions and indicators for review

Global PPS
Completed Global PPS at the AGHS during first visit in May 2019
All prescribing of antimicrobials was within the recommended guidelines and reviewed regularly
All treatment was empiric, due no timely access to microbiology lab

Community Engagement
The partnership successfully promoted the risks of antimicrobial prescribing within the hospital and wider community. The purchase of specialist equipment and use of local translators will enable the AGHS to continue engaging with the local people beyond the lifetime of the project.
The introduction of behaviour change to healthcare workers and the practical application of the theories discussed during training will enable the use of these tools in everyday work.

The engagement of local licensed drug sellers, community leaders and the radio station will ease the spread of future messages about antimicrobial resistance and other important public health messages.
How is the project to be developed in the future?

Looking for further opportunities to work with Assemblies of God Hospital to spread the antimicrobial stewardship message by working with other UK and Ghana partners in Northern region.

Gulu-Manchester link

Provide a brief overview of your project?
Submitted on behalf of the partnership team:
Our project is part of the Commonwealth Partnerships for Antimicrobial Stewardship scheme (CwPAMS) and is a collaboration of two hospitals in Northern Uganda, Health Education England HEE, Manchester University NHS Foundation Trust, Manchester Metropolitan University and The University of Manchester.

The aim of our project is to improve antimicrobial stewardship (AMS) practices and awareness of AMS in Gulu Regional Referral Hospital (GRRH) and St Marys hospital Lacor (SML).
Phase 1 scoping visit to Gulu by the UK team enabled the partners to:

• Gather baseline data on AMS practices, investigate barriers to “good prescribing practice” assessing other areas which impact on the use of antimicrobials.
• Assess the use of guidelines.
• Identify workable solutions to how AMS practices could be improved, an important part of the project in terms of practicality and sustainability.

Phase 2
Implement a co-developed training plan in Gulu and to undertake the Global Point Prevalence Survey (GPPS). During this phase we trained 212 healthcare professionals, with around 150 pledging online as Antibiotic Guardians.
The project has strengthened the AMS knowledge and skills of the 2 lead pharmacists in Gulu empowering them to take forward the principles of AMS and adapt them to local practices within their hospitals. The 2 lead pharmacists from GRRH and SML are key members of the partnership team and are leading the second phase of AMS training sessions in Gulu.

Our team has two volunteer psychologists who ensured that attitudes towards AMS were assessed and that behaviour change elements were integrated into our training. They are leading on the evaluation aspect of our project to prove the successes of the training.
The UK team was supported by AMS pharmacists, clinical pharmacists, physicians and a pharmacist from HEE who ensured that our learning objectives and lesson plans were focused and achievable.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
Over a 3 week period the team from Gulu and the UK trained 212 health care professionals in the principles of AMS, around 150 of these signed up as Antibiotic Guardians on the official website. 15 health care professionals trained as AMS trainers. These trainers are now equipped with the knowledge and skills to carry forward the training programme in their individual areas.
Global Point Prevalence Survey undertaken at 2 hospitals in Northern Uganda, this has never previously been undertaken in Gulu. Providing vital information to the worldwide project and providing the two hospitals in Gulu with local prescribing data. This was evaluated by the partners and action plans developed for future audits on the management of cellulitis and pneumonia at each hospital.
Local antimicrobial prescribing chart developed at GRRH, this will prompt prescribers to adhere to AMS standards when prescribing antimicrobials for inpatients.
How is the project to be developed in the future?

• Further training sessions led by the 2 lead Ugandan pharmacists planned at the end of March – training another 75 healthcare professionals.
• Evaluation of the training provided and the impact on prescribing practices.
• Each hospital has a Medicines Therapeutics Committee; the next steps of this project are to develop an Antimicrobial Stewardship Committee at each hospital.

Healthcare Improvement Scotland

Provide a brief overview of your project?
The Scottish Antimicrobial Prescribing Group (SAPG), a multidisciplinary national group who oversee antimicrobial stewardship in Scotland, secured a global volunteering grant from the Fleming Fund’s Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) to work with 2 hospitals in Ghana.

The SAPG team (antimicrobial pharmacists, antimicrobial nurses, Infectious Disease Consultants and researchers from the University of Strathclyde), created a partnership with lead pharmacists in Ghana Police Hospital (GPH), Accra, and Keta Municipal Hospital (KMH), Volta Region, to support the development of antimicrobial stewardship. The project was also supported by health psychologists from The Change Exchange.

The SAPG triad approach to stewardship (Information, Education and Quality Improvement) was applied with behaviour change concepts incorporated throughout with the aim of developing a robust and crucially sustainable antimicrobial stewardship programme in each hospital.
The project comprised three visits by the Scottish team and The Change Exchange to Ghana and one by the Ghanaian partners to Scotland to demonstrate stewardship embedded at local and national level.

At the initial visit in May’19 a multi-professional group from SAPG visited both hospitals and supported data collection on antibiotic use for a baseline Point Prevalence Survey (PPS) using the Global PPS system. On the second visit in September’19 two separate multi-professional groups worked with Lead Partners to provide 2 x 1-day ‘train the trainer’ education in each hospital, including a fun interactive Antibiotic Guardian session, a roleplay behaviour change session and use of the CwPAMS microguide app. Training was evaluated to assess the change in knowledge and behaviours of participants before and after the session. Local pharmacist-led antimicrobial teams agreed an action plan and a Quality Improvement project.

Local Ghana teams cascaded training to other staff and conducted a second PPS which the SAPG team reviewed and discussed on the 3rd visit in February’20 and agreed next steps.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
Information: Baseline PPS provided data on antibiotic use in each hospital, which informed education sessions and identified areas for improvement. Key findings included non-compliance with antibiotic guidelines, gaps within the national guidelines and long duration of treatment. This was the first use of the Global PPS in Ghana so we published the results in February’20 including comparisons with other African nations to support others to participate. Both hospitals are now able to complete PPS independently and have committed to ongoing PPS to support their stewardship ambitions.

Education: A total of 60 staff across the two hospitals (28 GPH and 32 KMH) were trained by the SAPG team. Over 100 additional staff were trained by the local antibiotic stewardship teams and both hospitals have committed to ongoing staff training.

Feedback suggested that participants found the training very useful and engaging. Analysis of pre and post participant quiz responses showed highly significant changes in knowledge. Key changes from behaviour surveys included: improved awareness of AMR; Ability to access and adhere to the guidelines; Increased confidence to question colleagues about prescriptions. During the 3rd visit discussions with nursing staff indicated that behaviours and practice had changed and identified some ongoing barriers for further consideration.

Quality Improvement: Both hospitals now have an established antimicrobial stewardship team who meet monthly (Since Dec’19) and will ensure sustainable ongoing antimicrobial stewardship. In both hospitals antibiotic policies for locally agreed common conditions were created via collaboration with hospital staff and laminated A3 colour posters of policies were provided during the final visit. To address guidance missing from National Ghana guidance GPH have designed local Antibiotic policies for Obstetrics and Gynaecology and Wound infections, and plan surgical prophylaxis guidelines . KMH focused on a quality improvement project optimising management of pneumonia in the Out-Patients Department.
How is the project to be developed in the future?
Ongoing virtual collaboration to support AMS programmes in both hospitals and support to cascade to other hospitals. Ongoing engagement with MOH, Ghana Pharmaceutical Society and universities.

European Wound Management Association

Provide a brief overview of your project?
*Massive Open Online Course – Antimicrobial Stewardship in Wound Care*
This project was jointly developed by the European Wound Management Association (EWMA) and the British Society for Antimicrobial Chemotherapy (BSAC), led by a project group of international key opinion leaders headed by Professor Karen Ousey, University of Huddersfield.

The online course translates evidence and national/international guidance focused on antimicrobial stewardship, wound diagnostics and infection prevention and control into clinically applicable learning. The course is freely available for people to access, although aimed primarily at health care professionals (HCPs) involved in wound care, e.g. doctors, nurses, pharmacists, and microbiologists. However there has been a proportion of patients and carers who have accessed the course.

To date, we have had nearly 3000 learners on the course, from 128 countries, the course, offered every 3 months, is planned to continue at least throughout 2020, with plans to translate into other languages.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

1. Nearly 3000 international learners have completed the course, allowing them to learn and understand crucial skills and knowledge related to the diagnosis of wound infection, appropriate treatment of wound infection with antibiotics and how to implement antimicrobial stewardship in clinical practice – thus offering them the ability to teach other HCPs and patients.
2. Following course feedback it is apparent that leaners are now aware of effective antibiotic practice and are referring to international and local guidance in the administration and constant re-evaluation of antibiotic use.
3. BSAC is entirely dedicated to the issues concerning antimicrobial use and has been spearheading the agenda by advocating the need for the effective use of antimicrobials. However, collaborating with practitioners’ associations like EWMA has allowed for the concept of antimicrobial stewardship to be related to specialist area of wound care. This has ensured this vital education is shared with HCPs globally.

How is the project to be developed in the future?
Due to the success of the project it will remain a part of the ongoing EWMA/BSAC AMS Programme for wound Care that has existed since 2015. We plan to further develop content in line with international guidance from WHO and other recognized bodies, e.g. CDC, NICE. The course will remain online to maintain flexibility for learners to access. We will translate into the main European languages, e.g. Spanish again to ensure the course is easily accessible for all. Presentably both EWMA and BSAC promote the course and the concept of AMS/AMR via conference symposia as well as communication on SoMe and through member channels. We intend to further develop our marketing of this free course through collaboration with wound care industry colleagues who will be advertise on their own websites and promote when visiting HCPs in clinical areas.

Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET)

Provide a brief overview of your project?
The Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) scheme aimed to leverage expertise of UK health institutions and technical experts to strengthen the capacity of the national health workforce and institutions in Ghana, Tanzania, Uganda and Zambia, to address AMR challenges through antimicrobial stewardship (AMS).

This has been achieved by the granting of funds for 12 health partnership projects (partnerships between UK institutions and their peers in LMICs) where NHS health workers volunteered their time to co-develop strategies and share skills and knowledge to address issues related to: AMS (including surveillance), antimicrobial pharmacy expertise and capacity and if contextually appropriate, infection prevention control (IPC). This has provided mutual benefit for both the local health workforce and UK teams, who have developed leadership skills and gained a new understanding of a global issue and how to find innovative approaches to tackle it in resource limited settings.

Key stakeholders include the Department of Health and Social Care (DHSC), the respective Ministries of Health in Ghana, Tanzania, Uganda and Zambia, other Fleming Fund implementing partners and the successful health partnerships and organisations that constitute them. CwPAMS has supported countries in collecting high quality data relevant to AMR that can now be shared and used nationally and globally to better understand the scale and scope of the problem of AMR in order to effectively tackle it.

CwPAMS, delivered by the Tropical Health & Education Trust and the Commonwealth Pharmacists Association has achieved three objectives:

• Developed and supported implementation of protocols and guidance for AMR surveillance and antimicrobial use in 12 health institutions located in four African LMIC countries
• Advocated for collection and application of data to promote rational use of antimicrobials, including initiating participation in the Global Point Prevalence Survey (G-PPS)
• Collated and analysed data on the sale and use of antimicrobials.

Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

1. Institutions demonstrate improved knowledge and practice in AMS, prescribing and IPC.
   Partnerships conducted 10 Point Prevalence Surveys, trained 670 LMIC health workers in the World Health Organisation’s (WHO) AWaRE antibiotic categories, AMS, IPC, and developed four documents regarding AMS.
2. Evidence of effective AMR interventions, with standardised tools and guidance used by local institutions and/or national partners.Country-specific AMS toolkits were developed, including reference lists, scoping studies and an international resource handbook.
   • An AMS checklist was developed for CwPAMS partnerships after a modified Delphi technique with representatives from partnerships.
   • A behaviour checklist was developed in collaboration with the Change Exchange to identify knowledge, attitudes and perspectives of healthcare staff, related to antibiotic use and prescribing/administration. A scoping study highlighted lack of understanding of behavioural drivers of AMS.
   • By May 2020, an AMS team will be established at each LMIC healthcare institution, along with quality assured AMS guidelines, tools and protocols and increased adherence to WHO AWaRE categories. This should significantly decrease use of broad-spectrum antibiotics.
     The CwPAMS app provides first time, easy access to infection management resources to improve appropriate prescribing in-line with national and international guidelines. Resources include WHO essential medicines list, surveillance tools, AMS training, IPC resources, and Standard Treatment Guidelines. Within 7 months of the app launch, 385 downloads occurred.
3. NHS staff demonstrate increased leadership skills, confidence in antimicrobial stewardship practices, and understanding of the global context of AMR.815 volunteering days were contributed by NHS staff. After training, >60% of volunteers had greater understanding of international development and health partnership principles and opportunities to form new links with others. Volunteers able to list three to five barriers of AMS in low and middle-income contexts and ways to overcome them increased 100% and knowledge of tackling AMR through IPC (specifically hand hygiene), increased 28%

How is the project to be developed in the future?
The CPA are collating resources generated by the CwPAMS project and will make these available in the form of a publicly available toolkit of resources, a CPD programme and a train the trainer package.

The CPA and THET are currently applying to the UK DHSC for a grant to continue the CwPAMS work focusing on ensuring the sustainability of the first phase of CwPAMS in the same health institutions across Ghana, Tanzania, Uganda and Zambia currently involved in the scheme, as well as rolling out AMS programmes to other health institutions.

Replicating the success of the first phase of CwPAMS, the new project would also include additional partnerships becoming eligible to apply for grants in Kenya, Malawi, Nigeria and Sierra Leone. These countries were chosen according to a range of criteria, including their location, priority ranking and current existing networks.

In phase two, the CPA and THET also aim to broaden partnership interventions beyond hospital level projects focussed on human health to multidisciplinary projects taking a ‘One Health’ approach to AMS. Replicating one highly successful project that was run in Uganda during the first round of the CwPAMS programme, partnerships would expand beyond human health specialists, emulating a multidisciplinary approach involving professionals from pharmacy, public health, microbiology, social sciences, environmental sciences, agriculture, medicine and veterinary.

Africa CDC

Provide a brief overview of your project?
Leveraging on the institutional authority from the African Union, Africa CDC has led a process of setting up an interagency African Union Task Force on Antimicrobial Resistance to implement continent-wide programs to address AMR using the One Health approach that focus on improving surveillance, delaying emergence, limiting transmission, and mitigating harm from AMR pathogens.
The African Union Commission through the endorsement of the AU Task Force on AMR reiterated its commitment to support Member States in their efforts to control antimicrobial resistance (AMR) at the national and subnational levels. The Task Force is uniquely positioned to promote continent-wide One Health policy that addresses AMR and other One Health issues and advocate across all sectors of government and society, based on the work of WHO, FAO, OIE, non-governmental organizations, and other partners. The task force is leading activities conducted by AU organs, Regional Economic Communities and relevant partners, including resource mobilization, resource sharing, advocacy, and high-level political engagement
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

1. With the support of Member States and partners, the AU Task Force has led a high-level political advocacy. At the 33rd African Union Summit in February 2020, the African Heads of States and Governments have announced a strong political commitment to controlling antimicrobial resistance in Africa by endorsing the “African Common Position on AMR”
2. Celebrated the first World Antibiotics Awareness Week- Africa 2019 Africa Union Task Force on AMR, the Africa Tripartite Regional Coordination Group (FAO, OIE, WHO) and the Regional Economic Communities in collaboration with the Government of Kenya and members of Kenya AMR Secretariat, jointly organised the first Africa Regional World Antibiotic Awareness Week (WAAW), under the theme ‘Handle Antibiotics with Care’. The week-long event included a press conference, high-level advocacy event and a continental coordination meeting. Africa CDC launched the pan African Antibiotic Guardian page https://antibioticguardian.com/africa/
3. Trained 25 Civil Society Organisations and set up the community of practice for CSOs to further strengthen their capacity for AMR advocacy and community engagement.

How is the project to be developed in the future?
The African Union Task Force and the regional tripartite organisations have agreed to set up an African Interagency Coordination Group to synergise the efforts of the African Union Commission and the Regional Tripartite Organisations to control AMR in the continent.

Brighton & Sussex University Hospitals, University Teaching Hospital – Lusaka, Brighton & Sussex Medical School, University of Zambia, University of Brighton, University of Sussex

Provide a brief overview of your project?
The Brighton-Lusaka Pharmacist Link is a health partnership whose major focus to date has been to enhance antimicrobial stewardship (AMS) through sharing up-to-date evidence and implementing best practice. In 2019 the link was awarded a Commonwealth Partnerships for Antimicrobial Stewardship Scheme (CwPAMS) grant to improve AMS and infection prevention and control at University Teaching Hospitals, Lusaka, Zambia (UTH). A further grant from the Tropical Health Education Trust (THET) has enabled countrywide dissemination of capability to manufacture locally, WHO alcohol handrub. In June 2019, the link hosted a three-day conference in Zambia for government level stakeholders plus pharmacists, physicians, nurses and allied healthcare professionals from UTH. This included workshops covering subjects such as global and local antimicrobial resistance patterns, behaviour change, global point prevalence survey training, use of defined daily doses to monitor antimicrobial consumption, infection prevention and control strategies such as handwashing and bare below the elbow initiatives and ‘train the trainer’ methodology. A reciprocal visit to the UK that same year allowed opportunity for first-hand experience of AMS ward-rounds, infectious diseases clinical pharmacy services including OPAT, mandatory infection control education provided to all healthcare staff and inter-professional learning.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

1. Appointment of an AMS pharmacist and establishment of a multidisciplinary Antimicrobial Stewardship Group at UTH, who have overseen, with support from the Link, the introduction of a dedicated antimicrobial prescribing chart, updated local antimicrobial guidelines and developed an AMS training programme which is currently undergoing accreditation by the University of Zambia for professional recognition. Two global point prevalence surveys have been undertaken so far to establish baseline consumption data and to start to measure the impact of interventions.
2. Installation of facility (start-up equipment & materials), pharmacist training in the theory and practical techniques of alcohol handrub production and quality control to enable local manufacture of WHO alcohol handrub. Production has newly commenced at four public tertiary teaching Zambian Hospitals with 28 hospital staff trained (23 pharmacists, 3 pharmacy technologists, 1 laboratory technologist and 1 environmental health technologist). Educational videos have been developed in association with the Commonwealth Pharmacy Association to support this initiative. This has been a very timely and pertinent intervention as has coincided with the global COVID-19 pandemic and has provided an opportunity for bi-directional learning. Inspired by the link, the University of Brighton manufactured alcohol handrub which was packaged by the Pharmacy Department at Brighton & Sussex University Hospitals for use throughout the Trust.
3. 34 infection prevention & control champions trained and ‘Bare Below the Elbows’ adopted by the Hospital Pharmacists Association of Zambia (HOPAZ).

How is the project to be developed in the future?
The future focus of the project is to up-scale and enhance audit and monitoring to ensure outputs are useful and of benefit e.g. regular hospital-wide global point prevalence surveys, measurement of antimicrobial consumption using defined daily doses. Further determination of barriers to change, including behavioural, is important to support widespread local and National dissemination. The ambition of the Ministry of Health in Zambia is that UTH becomes a centre of AMS excellence and a hub for National adoption.