BehGen POC One-Health Surveillance

Our solution (BehGen POC) brings together advanced genomic technology and community socio-behavioral data including gender to develop an integrated sustainable One-Health surveillance tool.  

Mr. Sakiusa Baleivanualala – Primary Investigator

Fiji is an economic, educational, and technological hub in the Pacific.  Studies show transmission of antimicrobial resistance (AMR) pathogens in major hospitals of Fiji and a potential AMR source in the Oceania region. Genetic links between A. baumannii isolates from Fiji and other countries suggest regional spread (Figure 1). Another Fiji hospital-based study showed over  60% of patients had carbapenem-resistant Acinetobacter baumannii, with a 40-fold increase in carbapenem usage since 2007. Third-generation cephalosporin resistance was found to be common in Fiji hospitals and communities. Seventy-six percent of juice sold by street vendors had Enterobacterales of which 4% were ESBL producers. However, the spread remains poorly understood.

Fiji faces socio-economic challenges that heighten AMR's vulnerability.  Thirty percent of the population dispose sewerage directly into environments, with pour-flush latrines common in rural, peri-urban, and informal settlements. Fiji experiences increased population mobility with high rates of international travelers and urbanization; 20% of the urban population lives in informal settlements. Climate-change-induced natural disasters, fuel food insecurity and climate-sensitive infections that increase AMR. 

Fiji lacks surveillance linking human, food, and environmental data. Our solution focuses on developing an AMR surveillance tool within the One Health spectrum. 

We engage in community education efforts targeting various groups, such as urban informal residents, food handlers, livestock workers, students, seasonal workers, and returning soldiers, to raise awareness about AMR through surveys, interviews, and sample collection. Collecting gender data during surveys enables targeted interventions and policies to address specific AMR. Additionally, we strengthen surveillance in the food industry by tracking AMR and antimicrobial usage (AMU) from different industry levels and informal vendors and identifying transmission pathways.

Collaboration with environmental scientists leverages local expertise in water quality assessment, environmental sampling, and data analysis to integrate surveillance data. This aids in identifying environmental reservoirs contributing to AMR and understanding interactions between humans, animals, food, and the environment in transmission. Engagement with policymakers, regulatory agencies, and stakeholders promotes multisectoral approaches for AMR management. Through workshops, training, and community outreach, we enhance awareness and capacity building. 

Locally, our solution integrates laboratory capabilities and surveillance systems to implement phenotypic and ONT sequencing for AMR surveillance. Addressing laboratory needs and providing personnel training ensures skilled individuals conduct analyses. We also support Master's students in One Health AMR surveillance.

Generation of Knowledge: Integrated epidemiological, genomic analysis and social-behavioral analysis on AMR will generate knowledge. This is disseminated through peer-reviewed publications, white papers, and public presentations, contributing to the global understanding of AMR dynamics. Awareness and education will be conducted among communities and stakeholders as part of cultural reciprocity during the social-behavioral research 

Open-access Data: Data from the research will be made available through open-access databases in the data repository at the Fiji National University. This will provide valuable insights for researchers, policymakers, public health practitioners, clinicians, animal health specialists, and environmental scientists worldwide. This includes genomic data, surveillance findings, and social-behavioral information through publicly accessible databases. 

Provision of Awareness and Capacity Building:  Community awareness and education including antimicrobial stewardship will be conducted. Capacity building will also be undertaken among officers involved in human, environmental, and animal surveillance.

Provision of Surveillance Products: Tools and resources to support AMR surveillance and management will be developed, including point-of-care testing kits for antibiotic residues and resistant genes. These products are made available at cost or through partnerships with local human and animal health authorities, ensuring affordability and accessibility for communities in need

Improved Health Outcomes: We will integrate data from human, animal (companion), and environmental (food and water) sources. This will enable early detection of AMR pathogens and facilitate targeted interventions to mitigate their spread. This leads to reduced rates of AMR-related infections and improved treatment outcomes among humans and animals over time.

Enhanced Community Engagement: We will empower communities with vulnerable populations (e.g. informal settlements, rural communities, and mobile populations), including women, to adopt and promote responsible antimicrobial use and hygiene and infection prevention measures. Community education and awareness campaigns will be undertaken. This will result in increased community engagement and ownership of AMR prevention efforts and a greater understanding of the importance of preserving antimicrobial effectiveness.
Strengthened Healthcare Systems: We will contribute to the development of evidence-based policies and interventions for AMR management, by informing decision-makers and stakeholders. This will enhance human and animal healthcare systems to effectively address AMR and ensure the continued availability of effective antimicrobial treatments.
Sustainable Surveillance Infrastructure: Our solution will enable ongoing monitoring of AMR trends and transmission pathways, by establishing a point-of-care sequencing technology and sustainable surveillance mechanisms,  This will facilitate timely responses to emerging AMR threats and contribute valuable genomic data to global surveillance efforts.

1st year: we will build partnerships with relevant decision-making bodies including government ministries and civil society stakeholders so that the AMR surveillance tool is more readily accepted and more beneficiaries under the stewardship of these bodies are effectively reached. Target communities will be approached for collaboration, so that they are more responsive to the research and able to provide a deeper and more accurate understanding of AMR use and transmission.  

2nd year: research findings will be used and expanded to develop an AMR surveillance tool that is scaled to pilot sites throughout Fiji. Human and animal health officers will be trained so that they can independently conduct AMR surveillance. The AMR surveillance tool and processes will be integrated with the national health surveillance system to ensure efficiency.

3rd year: relevant AMR SOPs and policies will be developed to ensure a more efficient surveillance system. Other Pacific countries (Solomon Islands, Kiribati, Samoa) will be explored to expand AMR surveillance regionally   

Impact goal:  strengthen Fiji's AMR surveillance system as outlined in the Fiji AMR  National Action Plan 2022-2025.

Policy Impact: This will be assessed based on evidence-based policies and interventions for AMR prevention and control, including the adoption of policy recommendations by stakeholders and the development of AMR SOPs and policies.

Sustainability Impact: Sustainability will be measured by capacity-building efforts, institutional support levels, funding mechanisms, and integration between new and existing surveillance systems.

Capacity Building Impact: Training programs will target healthcare professionals, animal health specialists, and environmental officers. Workshops on AMR governance and policy development will be established, along with mentorship opportunities and successful Masters dissertations on AMR.

Community Impact: Community awareness sessions will educate health workers, farmers, and food handlers on AMR prevention strategies, with ongoing monitoring of training sessions to ensure community engagement

Logistical barriers like communication challenges and high transportation costs, are addressed through web-based platforms and affordable communication gadgets.   

Cultural barriers like varying traditional customs, values, and languages, are tackled through community awareness and education with trained data collectors targeting specific ethnic groups.   

Fiji also lacks a specific AMR policy, which can be mitigated by creating awareness among key stakeholders and the provision of baseline information.   

Weak multisectoral collaboration barriers are addressed through open communication and exploration of ways to review National AMR Committee (NARC) terms of reference, delineate its tasks, and establish a research arm. These strategies ensure a holistic approach to overcome barriers and implement the solution effectively.

Our solution to develop and implement a sustainable AMR surveillance tool is founded on the principle of collaboration and partnership. We recognize the value of forming strategic alliances with various stakeholders to scale our initiative effectively. Our approach to partnerships involves engaging with a diverse range of organizations, including academic and research institutions.

To address AMR comprehensively in Fiji and the Pacific, we seek partnerships with entities that can provide expertise, resources, and support in key areas such as surveillance, research, capacity building, policy development, and community engagement. These partnerships will enable us to leverage additional funding, access cutting-edge technologies and innovations, expand our reach, and strengthen the sustainability of our efforts.

As the Trinity Challenge on AMR progresses, we are eager to connect with the Steering Committee members and partners associated with the initiative. We anticipate that these connections will offer valuable opportunities for collaboration, knowledge sharing, and resource mobilization to advance our solution and contribute meaningfully to the global fight against AMR.

Partnering with Trinity Challenge members, the University of Otago, Massey Unversity, ESR, and NZ would enhance our solution's impact by leveraging their extensive networks, knowledge, and resources in the health sector. This collaboration would facilitate access to funding, technical assistance, and mentorship, enabling us to implement comprehensive AMR interventions and contribute significantly to global efforts in combating AMR.