AMUVet, an antimicrobial use data collection tool for animal health

AMUVet is an integrated digital application to collect and analyse antimicrobial use (AMU) data in animal health systems.

AMUVet takes advantage of the vast expertise in antimicrobial stewardship of our team with readily available technology to leverage AMU data collection and facilitate decision-making at multiple levels.

The Team Lead is Dr Mauricio Coppo, Research Fellow (International Antimicrobial Stewardship) at the Asia-Pacific Centre for Animal Health, the University of Melbourne.

Antimicrobial resistance (AMR) and use (AMU) data available for analysis and epidemiological modelling come primarily from first-world countries. Despite current efforts focussed on strengthening AMR and AMU surveillance in primary production settings, the lack of reliable data from low- and middle-Income countries (LMICs) remains a challenge for decision making at local, regional and global levels. Aligned with the WHO Global Action Plan on AMR, the FAO Action Plan on AMR (2021-2025) has identified strengthening AMR and AMU surveillance in primary production sectors and across the whole food chain are key focus areas.

Although approximately half of LMICs reported quantitative data on antimicrobial consumption (AMC) to the WOAH in 2022 (Annual Report on

Antimicrobial Agents Intended for Use in Animals), the majority were unable to report data segregated by animal species or route of administration. Typically, AMC estimates are derived from country level antimicrobial import or sales data. Additionally, the absence of a framework for AMC data collection and limited access to AMU data collection tools hinder the ability of LMICs to conduct accurate analyses and establish effective strategies to inform policy changes aimed at controlling the emergence and spread of AMR.

The target end-users are those who use or prescribe antimicrobials to animals, including farmers, animal production extension officers, para-veterinarians, veterinarians, aquaculture specialists and those who work in Agrivet shops. AMUVet is particularly useful for field animal health workers or livestock extension officers who prescribe or administer antimicrobials to animals as part of their routine work. AMUVet could also be targeted at farmers in key priority areas, such as those in semi-industrial settings for pig production, poultry farms in FAO Sector 3 (Commercial chicken production system with low to minimal biosecurity and chicken/products sold in live chicken markets), or the aquaculture sector.

Government officials in charge of data analytics are the target users for integrated data analysis and epidemiological studies. Results from such studies can be used to leverage decision-making and policy change.

We are currently working with a number of LMICs in South and Southeast Asia, and the Pacific. AMUVet helps address several challenges we have identified in AMU data collection and analysis, such as limited access to reliable tools for AMU data collection, limited resources (human and material) for conducting analysis, and challenges in the effective translation of surveillance data to policy change.

AMUVet provides a valuable public good by offering a solution for acquiring community-level AMU data that may otherwise go uncollected or unanalysed. This data serves as a critical resource for raising awareness and promoting responsible antimicrobial use among prescribers and users. Additionally, it informs decision-making at the government level, facilitating the design and implementation of evidence-based policies to address antimicrobial resistance in the animal health sector. More specifically, AMUVet contributes to:

• Enhancing animal health and welfare, by helping to optimise antimicrobial treatments in animals.
• Facilitating sustainable agriculture systems and food security, by nhancing the productivity of livestock and aquaculture sectors.
• Protecting public health, by helping to preserve the effectiveness of antimicrobials for treating human infections.
• Strengthening environmental conservation, by reducing the release of antimicrobial residues and antimicrobial-resistant bacteria into the environment.
• Economic benefits, by helping to reduce the prevalence of antimicrobial resistance, thus helping to mitigate the economic costs associated with treating resistant infections in both animals and humans.

Strengthening AMU surveillance is a key objective of the FAO Action Plan for AMR in the agriculture and food sectors. However, there is a dearth of access to digital tools that can provide an integrated approach to AMU data collection and analysis, particularly in LMICs.

AMUVet provides antimicrobial prescribers and users access to an easy to use data collection tool, and easy to understand data dashboards. Access to data, and more importantly, access to information at the individual level is the first step towards a targeted approach to appropriate use of antimicrobials in the field, and provides the basis for benchmarking across antimicrobial users according to categorical data (e.g.: animal species, production system, geographical location). Benchmarking is valuable because it enables peer comparisons that might help drive reductions in unnecessary usage.

At a higher level, AMUVet provides a streamlined source of data for government organisations responsible for monitoring AMC/U in the agriculture and food sectors, thus facilitating the development, implementation and monitoring of evidence-based antimicrobial stewardship initiatives, awareness or education campaigns, and policy-change.

Our operational model describes our deployment strategy during the first year and over the next three years. Briefly, we aim to be able to launch AMUVet in four countries during the first year and scale up to a further three countries over years 2-3. This is reflected in the budget that has been prepared. 

During the first year our focus will be on adapting AMUVet to local contexts in countries with relatively small animal production sectors and veterinary workforces. The four countries selected for initial deployment have been chosen based on ongoing working relationships and preliminary feasibility assessments. The subsequent countries to join the programme will be based on the results of ongoing scoping processes currently underway in all countries mentioned and will include countries with much larger animal production sectors and veterinary workforces.

This model ensures a sound scale-up strategy that relies on established working relationships, a comprehensive situational assessment and scoping process, and progressive implementation in countries with increasing numbers of users and increasingly complex primary production systems and food value chains.

There are a few measures of impact that we are planning to use during the progress of this project.

The first one is coverage or adoption of the solution. At a pilot level initially, and then in a broader geographical context, the number of countries adopting the solution and the number of users in each country will help monitor its impact in terms of representativeness (e.g.: relative to livestock census data or potential number of users). We will also assess the quality and quantity of data collected through AMUVet, including the completeness, accuracy, and timeliness of antimicrobial usage data.

User satisfaction and feedback will be gathered, and areas for improvement identified.

Analysis of prescribing behaviours, and specifically appropriateness of use based on antimicrobial use guidelines, will be utilised as a key indicator of the impact of AMUVet. Importantly, through these analyses, government agencies will be able to gain an understanding of AMU patterns at provincial or national levels for decision-making. The development, implementation and adoption of policies facilitated by AMUVet will also be tracked.

Insufficient resources (human, financial, technological) to complete the development, optimisation and testing of this solution in the context of AMU data collection in LMICs poses the most important barrier to implementation of AMUVet in the next year. Such resources are also necessary to facilitate coordination with governments and other stakeholders at the local level for adaptation and adoption, training, and collection of baseline data for monitoring impact.

Access to limited resources (human, financial, technical) in LMICs, and especially in government agencies in charge of animal health, means staff  face multiple competing priorities, where antimicrobial resistance (AMR) is seen as an important problem that needs attention, but not urgently. Current efforts funded by international aid organisations are focussed on raising awareness of AMR and increasing the scope and scale of AMR and AMU surveillance programmes in the public health and animal health systems in LMICs, and are thus likely to help overcome this barrier in the mid-term.

We are applying to the Trinity Challenge on Antimicrobial Resistance because we believe that data-driven solutions are the key to impactful evidence-based policy and decision-making. The Trinity Challenge opens avenues for us to make a real contribution to help strengthen AMU surveillance in LMICs, and to promote responsible antimicrobial stewardship practices. 

We have met, mentored, trained and worked with animal health professionals, scientists, technicians and decision-makers in LMICs, and we currently hold projects in ten countries in the Asia-Pacific Region. AMUVet is a solution that directly addresses some of the significant barriers we have identified through this work and these relationships.

Given the nature of our solution, collaborations with government agencies, field practitioners and data analysts are essential for the success of this initiative, throughout the duration of this project and beyond.

The World Organisation for Animal Health (WOAH, formerly OIE) is the international agency in charge of collecting antimicrobial consumption data from member countries. A synergistic collaboration with this organisation would ensure alignment of objectives to avoid duplication of efforts.

The sustainability of this solution would require additional funding to support ongoing operation of the application and the technological platforms that support it beyond the three year duration of this project. Connections with technology partners that may be able to provide this ongoing support would also be beneficial. 

Fleming Fund managing agency Mott MacDonald invited us (and others) to participate in an information sharing session about this initiative and made us aware of the call for applications.