Antimicrobial Resistance (AMR) surveillance rides on CLM (AMR on CLM)

The innovation will work with people living with or at risk of acquiring HIV/AIDS and TB to capture data on Antimicrobial Consumption, Use (AMR/C/U)and resistance under One Health using Community Led Monitoring (CLM) approach. HEPS Uganda has an Online application CommCare which will be expanded to add AMR indicators.

Mr. Kenneth Mwehonge - Executive Director

• The innovation will address the lack of a community-led system for AMR/C/U surveillance. There is no system for community people who are end-users of antibiotics to lead in reporting the risk factors, accelerators and drivers of AMR. AMR interventions lack the community insight in identifying the issues and providing evidence to inform action at different levels. 
• The main cause of this problem is the limited budget that is allocated to the Health sector and the One Health Platform in Uganda. This makes community involvement in AMR surveillance lowest on the list of priorities for investment. There are equally no tools to support community level surveillance. The One Health structure does not include communities. 
• Our solution will provide tools and resources to kickstart community involvement in AMR/C/U surveillance and will provide the evidence to drum support for the initiative.
• AMR is spreading like wildfire in humans and farming activities alike. According to AMR National Action Plan (NAP) for Uganda 2018-23, the increasing prevalence and distribution of AMR threatens to undermine decades of progress in effective prevention and control of infectious diseases. In Uganda in 2019, there were 30,700 deaths associated with AMR according to the same plan.

Community: The solution primarily targets community members (HIV/TB clients and farmers groups) who are the end-users of antibiotics. 

The needs:

• The solution will fill their information and knowledge gaps on AMR and what they can be do to address this. It will provide them with tools to facilitate active participation in data collection on AMR.

One Health Community structures: Are secondary targets.

• Community workers (VHTs, Agricultural Extension workers, Environmental Protection groups, Water user committees) need to know more about AMR; prevalence and trends to inform their actions in the community.

Policy Makers:

• The data will help in mapping out AMR hotspots to inform targeted interventions.

What we are you doing to understand their needs?

HEPS Uganda implements the CLM model, conducts review meetings, focused group discussions with PLHIV/TB and those at risk. HEPS is also key players in the national HIV and TB work. These help us understand their needs.

How are you engaging them as you develop the solution?

HEPS Uganda on a quarterly basis monitors the delivery of HIV/TB services through CLM, interacts with communities and conducts People's voice consultations. Our interactions had already pointed out the need to capture additional indicators on AMR and Adverse drug reactions. 

The solution mainly targets HIV and TB which are huge public health threats making it a public good. By providing readily available evidence on the prevalence, incidence and trends of AMR in human and animal/plant health, the proposed solution will inform policy as well as programming for better HIV/TB treatment outcomes as well as farming activities.

The increasing prevalence and geographic distribution of AMR threatens to undermine decades of progress in effective prevention and control of infectious diseases. Our solution is the missing piece in the AMR puzzle in Uganda. 

The AMR/C/U collated and analyzed data will be readily available for use on a free-to-use public dashboard.

The solution will increase the awareness level of communities on AMR and encourage them to take action to prevent and mitigate the effects. All these make the solution a public good.

Data will be collected by people living with and those at risk of HIV/TB. They will be in position to give first hand information and feedback regarding their needs and concerns to address AMR.

By borrowing from the CLM pillars of education, the innovation will fill knowledge and information gaps especially on the interconnectedness of human, animal, plant health and the environment to lead to behavior change on AMR among HIV TB clients. Taking the right actions will make their treatment efficacious and result in better treatment outcomes.

The data generated will provide evidence with which to engage decision-makers at various levels for better HIV and TB service delivery for the benefit of the target communities. 

By taking lead on the gathering data, the innovation will make communities active in presenting the trends, prevalence and incidence of AMR to inform the research agenda. The innovation will put communities in the right position to mitigate the occurrence of resistance in both HIV and TB and in farming activities. 

The evidence gathered by the communities will inform the development of health communication campaigns to meet their information needs to address AMR in humans, animals and the environment.

The innovation will start with the current 80 CLM coverage districts in the first year and over the period of 3 years, it will be scaled up to reach the entire country.

The evidence generated will be used to develop communication campaigns to increase awareness on AMR/C/U and the One Health.

The evidence will be used to influence the public health policies to mitigate AMR with communities in the lead.

HEPS Uganda develops a monitoring  and evaluation plan to detail how success will be measured. Currently the plan monitors awareness of health rights and responsibilities, evidence and experience with existing models of HIV/TB and SRHR services, the service delivery issues reported, actions suggested based on evidence, commitments made, health education at community level, service standards/minimum health care package provided for HIV/TB and SRHR services in public facilities, key projects and services, among others. For the proposed innovation, the specific measurable indicators at the goal level will be reduction in antibiotic misuse across target districts.

The specific objective indicators will include; the documented number of drivers and accelerators of AMR at community level, the number of  community members providing evidence for anti-biotic misuse, number of community monitors successfully using the online application to gather data.

Our plan will also  provide expected activities and outputs as well as the inputs at various levels. The plan will also include; means of verification and the possible assumptions. The innovation will track antimicrobial use and consumption pattern, knowledge on AMR and its drivers across all One Health sectors. 

Uganda's health system remains fairly unregulated and communities can access antibiotics wherever and whenever they feel the need. The end-users of antibiotics are not aware, neither involved in AMR prevention nor impact mitigation.

HEPS Uganda will develop a behavior change communication strategy to address awareness, attitude and information issues on AMR through different communication channels and strategies.

There is limited data on AMR and antimicrobial use especially from the primary sources. It is therefore not easy to get the actual baseline on the status of AMR in Uganda. This is majorly caused by the absence of AMR surveillance at community level. 

HEPS Uganda plans to address this by actively engaging communities in AMR surveillance.

Due to lack of up-to-date community level data and evidence, public policy interventions on AMR are haphazard and not necessarily based on community level evidence. 

The proposed innovation will change this by providing real-time data on the trends, incidence and hotspots for AMR for informed and targeted interventions.  

In addition, the local investments in AMR by the key stakeholders including Ministry of health is limited. This will be mitigated by aggressive fundraising from different sources. This solution will drum support for community involvement in AMR surveillance.

There are very few organizations and arrangements that are interested in AMR work beyond talking about it. Therefore no financial investments even at Ministry of Health put to do AMR surveillance at community level. This a golden opportunity to bring this issue to the fore and give it the attention that it deserves. The financial support accorded by the Trinity challenge is a step in the right direction.

The end users of antimicrobials are not aware, not involved gathering evidence and advocating for policies to prevent and mitigate the effects of AMR. This contributes to limited data on AMR and especially from primary sources. These are some of the gaps that this Trinity Challenge will help us address.

This one of the few calls that is interested in community engagement interventions. This opportunity enables  communities to be active in the fights against AMR. 

Public policy interventions on AMR are not informed by community level data. This is a great opportunity to showcase how CLM has been used to bring community voices and perspectives to inform decision-making. The use takes the Trinity challenge as an opportunity ride on CLM to collect AMR data at community level to inform policy.

• HEPS would be honored to collaborate with Bill and Melinda Gates, Wellcome, Johns Hopkins Bloomberg School of Public Health, facebook and Google. We are open to any organization that can help us accelerate and scale our solution. 
• We can also collaborate with One Health Trust, The World Health Organization, The Fleming Fund among others. These have a lot of expertise in AMR work and there is a lot that we can learn from them to make our solution better.
• This is an opportunity to market our solution to the outside world and to highlight the need for community engagement in AMR work.
• We hope to benefit from the technical expertise and financial support of the collaborators that the Trinity Challenge will offer.