Protocol for an interdisciplinary cross-sectional study investigating the social, biological and community-level drivers of antimicrobial resistance (AMR): Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA)
Year: 2021
Type: article
Study design: Study Protocol
Abstract: INTRODUCTION: Antimicrobial resistance (AMR) is a global health threat that requires urgent research using a multidisciplinary approach. The biological drivers of AMR are well understood, but factors related to treatment seeking and the social contexts of antibiotic (AB) use behaviours are less understood. Here we describe the Holistic Approach to Unravel Antibacterial Resistance in East Africa, a multicentre consortium that investigates the diverse drivers of drug resistance in urinary tract infections (UTIs) in East Africa. METHODS AND ANALYSIS: This study will take place in Uganda, Kenya and Tanzania. We will conduct geospatial mapping of AB sellers, and conduct mystery client studies and in-depth interviews (IDIs) with drug sellers to investigate AB provision practices. In parallel, we will conduct IDIs with doctors, alongside community focus groups. Clinically diagnosed patients with UTI will be recruited from healthcare centres, provide urine samples and complete a questionnaire capturing retrospective treatment pathways, sociodemographic characteristics, attitudes and knowledge. Bacterial isolates from urine and stool samples will be subject to culture and antibiotic sensitivity testing. Genomic DNA from bacterial isolates will be extracted with a subset being sequenced. A follow-up household interview will be conducted with 1800 UTI-positive patients, where further environmental samples will be collected. A subsample of patients will be interviewed using qualitative tools. Questionnaire data, microbiological analysis and qualitative data will be linked at the individual level. Quantitative data will be analysed using statistical modelling, including Bayesian network analysis, and all forms of qualitative data analysed through iterative thematic content analysis. ETHICS AND DISSEMINATION: Approvals have been obtained from all national and local ethical review bodies in East Africa and the UK. Results will be disseminated in communities, with local and global policy stakeholders, and in academic circles. They will have great potential to inform policy, improve clinical practice and build regional pathogen surveillance capacity.
Source: BMJ Open
Authors: Benon B. Asiimwe, John Kiiru, Stephen E. Mshana, Stella Neema, Katherine Keenan, Mike Kesby, Joseph R. Mwanga, Derek J. Sloan, Blandina T. Mmbaga, V Anne Smith, Stephen Gillespie, Andy G. Lynch, Alison Sandeman, John Stelling, Alison Elliott, David M. Aanensen, Gibson S. Kibiki, Wilber Sabiiti, Matthew T. G. Holden, Catherine Kansiime, Martha F. Mushi, Arun Gonzales Decano, Dominique L. Green, John Mwaniki, Nyanda E Ntinginya, Joel Bazira
Institutions: Makerere University, Kenya Medical Research Institute, Catholic University of Health and Allied Sciences, University of St Andrews, Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Brigham and Women's Hospital, London School of Hygiene & Tropical Medicine, MRC/UVRI & LSHTM Uganda Research Unit, Medical Research Council, Uganda Virus Research Institute, University of Oxford, Wellcome Trust, East African Health Research Commission, Mbarara University of Science and Technology
Language: English
Subfield: Applied Microbiology and Biotechnology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $1,839
Funders: Wellcome Trust, Government of the United Kingdom, National Institute for Health and Care Research, Department of Health and Social Care, European Commission, New Partnership for Africa's Development, African Academy of Sciences, National Institutes of Health, Medical Research Council, Economic and Social Research Council, Alliance for Accelerating Excellence in Science in Africa, National Cancer Institute, European and Developing Countries Clinical Trials Partnership
Awards: G127891921, Makerere University UVRI Centre of Excellence for Infection & Immunity Research and Training (MUII-plus), G2347075150, G3978449902, G4478621777, Centre for Population Change (Transition funding), G5718405750, G5734573445, G5951951904, G7063735130, G7171894324, G7279930290, G7471000213, G7853697249, G8297570641, G857320834, Holistic Approach To Unravel Antibacterial resistance in East Africa (HATUA), G8959201162, G9000075845, G9000097001
OpenAlex ID: W3135024082