This year has been a momentous one for the Global Antibiotic Partnership (GARP). The ball has been rolling since the 1st Global Forum on Bacterial Infections: Balancing Treatment Access and Antibiotic Resistance, which took place in New Delhi a little over one year ago. Most importantly, GARP has progressed from Phase 1 to Phase 2. What this means is that the accomplishments and outlook of the four GARP working groups that began in 2009 in India, Kenya, South Africa and Vietnam as well as the Global Forum, laid the groundwork for GARP to continue and to grow. Thus, for Phase 2, we are expanding GARP to eight countries, with four new countries joining our partnership.
??Below is a brief update on the many activities going on in the six GARP countries. Please click the links below to jump to a specific section of the update. As always, we welcome your questions and feedback.
Garp Country-Specific Activities
Garp Country-Specific Activities
GARP is serving as a consultant to the inter-sectoral committee on antibiotics in livestock. The objective of the committee is to present to the Ministry a situation analysis describing antibiotic use and resistance in livestock and to make policy recommendations in the next few months. In addition, Dr. Manish Kakkar from the GARP India Working Group is conducting a study to ascertain antibiotic use in food animals in India in order to explore its potential impact on human health. On the human side, medical societies have taken the lead where they convened on the 24th of August, 2012 to hold a symposium called A Roadmap to Tackle the Challenge of Antimicrobial Resistance . This meeting, held in Chennai, was the first of its kind held by medical societies.
There have been a number of policy changes in the last year. Due to the high out-of-pocket expenditure for health care, Shri Ghulam Nabi Azad (the Indian Minister of Health and Family Welfare) has proposed to provide free essential medicines to the public. More information on this is available here. The minister also recently met with Ms. Edit Schippers, the Minister of Health, Sports and Welfare from the Netherlands to strengthen bilateral cooperation on the rational use of medicines and antimicrobial resistance. More information is available here. Efforts to curb inappropriate drug use are increasingly visible: for example, the MoH advertisement above recently appeared in the Hindu newspaper.
For more information, contact Aleefia Somji (temporary GARP-India coordinator).
The GARP-Kenya working group is generating activities and becoming a more active network. Eveline Wesangula, the local coordinator is 1) exploring opportunities to further develop an AMR course created by the Ecumenical Pharmaceutical Network (EPN) and 2) seeking funding to expand a demonstration project based on a study of pre-surgical antibiotic prophylaxis. The GARP-Kenya working group met on August 15 to discuss priorities for new projects and work on previously decided policy activities, including: 1) antibiotic quality investigations by the Poisons and Pharmacy Board (PBB) and 2) a follow-up to previous work on the use of antibiotics in food animals.
To learn more about GARP-Kenya, contact Eveline Wesangula (GARP-Kenya coordinator).
The inaugural meeting of GARP-Mozambique was held on 2-3 August 2012. The Mozambican Health Minister opened the meeting and signed the New Delhi Call to Action. The meeting brought together working group members and stakeholders including WHO, USAID, the World Bank, and DFID for the first time. The chair of the GARP-Kenya working group, Dr. Samuel Kariuki, and the chair and co-chair of the GARP-South Africa working group, Drs. Adriano Duse and Olga Perovic, also joined the meeting. The working group is led by Chair Dr. Betuel Siga que from the Centro de Investiga o em Sa de de Manhi a (CISM) and co-Chair Dr. Esperan a Sevene from University Eduardo Mondlane. The fifteen working group members have a wide range of relevant expertise. Dr. Silvia Chicuecue, a DVM by training and also based at CISM, will be the working group coordinator. Please find the meeting minutes here. Identified priority areas for action (for which sub-groups were formed) were four-fold: antibiotic use and consumption, antibiotic quality, surveillance, and infection prevention and control.
Big updates from South Africa: the South African Minister of Health has signed on to the Call to Action and a coordinator, Kim Faure, has been hired full-time. Kim will start in January 2013. Planning continues for a GARP Phase 2 launch working group meeting that will likely take place in early 2013. This will be a one-and-one-half day meeting in Johannesburg, bringing together 1) the steering group, 2) other WG members, and 3) outside stakeholders who work in resistance and might take leadership for implementation of some of the recommendations. The purpose of the meeting is to develop an action plan for recommendation implementation over the medium and long term. They intend to prioritize work that can be accomplished by October 2014 the date of the 2nd Global Forum.
The inaugural meeting of the GARP-Tanzania working group was held on 13-14 August 2012. The chair, Dr. Said Aboud from Muhimbili University, spoke to the human side of the problem, while the vice-chair, Dr. Robinson Mdegela is a professor at Sokoine University of Agriculture and chief representative of the veterinary side. Working group members were represented by both public and private hospitals, the Ministry of Health and Social Welfare, the Ministry of Livestock and Fisheries Development, the National Laboratories, hospitals and research institutions from around the country.
To learn more, contact Aleefia Somji (GARP-Tanzania coordinator).
The Ministry of Health, along with WHO and the GARP-Vietnam working group, has begun to develop a national action plan to control antibiotic resistance for 2012-2020 time frame, that will rely heavily on the GARP situation analysis. The internet survey about colistin use, supported by GARP and initial findings of which were presented at the 1st Global Forum on Bacterial Infections, is complete and a manuscript has been submitted for publication. Also ready for publication is a summary of the GARP-Vietnam situation analysis. The working group met in March and focused on 1) finalizing the report on antibiotic use and resistance in 15 Vietnam hospitals in 2009 and publishing it on the MoH website, 2) writing a report on antibiotic use and residue in Vietnam aquaculture for publication, and 3) organizing a policy meeting with WHO, MoH and MARD. Minutes of the meeting are available here.
To learn more, contact Heiman Wertheim (GARP-Vietnam Working Group temporary coordinator).
Information materials were developed to assist the numerous individual facilities that have began piloting the use of this novel metric as part of their antimicrobial stewardship programs. Web discussions and training sessions will be held thorughout the next year with support from interested organizations. In addition, preparations for a multicenter chart review study are under way in three partner facilities, two of which are in GARP countries the Aga Khan University Medical Center in Nairobi, Kenya, and the Vellore Christian Medical College in Vellore, India. The investigation will collect clinical and microbiological data to assess the burden antimicrobial resistance. This data will be used to further develop and validate the concept of indexing antibiotic effectiveness.
For more information, please contact Nikolay Braykov.
Over the past year a model (the foundation of PneuMOD) on the reservoir and transmission dynamics of Streptococcus Pneumoniae has been developed. A paper describing the model is being submitted for publication. The model is currently poised to fit data describing the strain diversity of S. Pneumoniae and, following that process, the plan is to fit it to Kenyan data and conduct extensive policy analysis.
For more information, please contact Itamar Megiddo.