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South Africa ’ s Perspective on AMR

This presentation discusses the challenges and strategies related to antibiotic resistance in South Africa, including health barriers, stakeholder buy-in, national uniformity, and communication channels. It emphasizes the importance of collaboration, empowerment, and maintaining momentum after the situational analysis. The presentation concludes with examples of national initiatives and awareness campaigns.

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South Africa ’ s Perspective on AMR

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  1. South Africa’s Perspective on AMR Marc Mendelson @southafricanasp Division of Infectious Diseases and HIV Medicine Groote Schuur Hospital, University of Cape Town National Actions Contribute to a Global Solution• 3rd March 2016 • 17th ICID • Hyderabad

  2. AMR in the [South] African context

  3. Challenge 1Health barriers (which may differ) in each country often need to be understood and addressed before the issue of antibiotic resistance‘has room to breathe’

  4. Situational Analysis, 2011 S Afr Med J 2011; 8

  5. KPC VIM GES OXA-48-like GES GES NDM VIM NDM NDM Outbreaks involving carbapenemase resistance genes in South Africa NDM KPC OXA-48-like VIM Witbank OXA-48-like GES NDM VIM J Clin Micro 2013; 51(1): 369-72 SAMJ 2012; 102(7): 599-601 Slide courtesy of Adrian Brink

  6. The scale of antibiotic abuse started to become evident 1 patient simultaneously received: Cloxacillin Teicoplanin Metronidazole Amikacin Ceftazadime Meropenem Levofloxacin Erythromycin Co-trimoxazole Fluconazole Paruk et al. SAMJ 2012; 102(7): 613-6

  7. Challenge 2Maintaining impetus after the situational analysis.Part of any intervention must be empowerment of the country to take responsibility and ownership of antibiotic resistance

  8. Mendelson et al. S Afr Med J 2012;102(7):607-8

  9. Microbiologists Adult Infectious Diseases Specialists Paediatric Infectious Diseases Specialists Pharmacists Infection Control Practitioners Surgeons & Intensivists Animal Health microbiologists & Veterinarians Family Practitioners

  10. Challenge 3Need to decide where to start. Few countries can focus on multiple areas in the beginning.South Africa went for hospitals as the seat of most resistance

  11. National AMR Working Group is formed under leadership of DG within Essential Drugs Programme

  12. National AMR Summit, October 2014 Challenge 4: Buy-in from all stakeholders who need to commit

  13. Antimicrobial Resistance National Strategy Framework 2014-2024 Background Framework http://www.health.gov.za/index.php/component/phocadownload/category/199-antimicrobial-resistance

  14. Health Systems Strengthening, Research, Education, & Communication

  15. Challenge 5Development has clearly benefited from collaboration

  16. South African Antibiotic Consumption 3 sources of data

  17. Staphylococcus aureus resistance to oxacillin (%MRSA)

  18. Challenge 6Creating national uniformity. Towards equitable access to antibiotic stewardship expertise across the country

  19. National Training Centres for Antibiotic Stewardship • One week courses – daily AS rounds and taught component • Teams of 3 – Prescriber + Pharmacist + Hospital Manager • Targeted at underserved provinces first Groote Schuur Hospital

  20. Web-based ANTIMICROBIAL PRESCRIBING LICENSE • BOYLES • Dr TOM • 20.09.1971 United Kingdom • 4a. 16.10.2014 4b. National • Expires 15.10.2016 • Division of Infectious Diseases & HIV Medicine, Groote Schuur Hospital, Cape Town • Level 10 – full antimicrobial prescribing 22 podcasts with CPD accreditation forms the backbone of the training

  21. https://www.openlearning.com/courses/clinical-antibiotic-stewarship-for-south-Africahttps://www.openlearning.com/courses/clinical-antibiotic-stewarship-for-south-Africa

  22. National AMR Issues in Animal Health

  23. Antibiotics sold for animal health in South Africa, 2002 – 2004 Intramammaries (4%) 1. Penicillins (98%) Other dosage forms (1.5%) Water soluble (12%) Parenterals (17.5%) In-feeds (69%) Eagar et al. J S Afr Vet Assoc. 2012;83(1)

  24. Increasing colistin resistance in pathogenic E. coli in South African Poultry operations 19/24 E. coli strains with MIC ≥4 ml/ml from last quarter of 2015 contained the MCR-1 gene conferring colistin resistance V-Tech, 11th an 2016

  25. SA National Veterinary Surveillance and Monitoring Programme for Resistance to Antimicrobial Drugs

  26. Governance issues

  27. NAPHISA will enhance health system effectiveness • Support, expertise and advice to government to achieve improvements in health of the population • Mandated to provide • Coordinated disease and injury surveillance • Research and training • Workforce development • Monitoring and evaluation of services and interventions directed towards major health problems affecting the population http://www.nioh.ac.za/assets/files/NAPHISA_BILL_FOR_COMMENT_39392_gon1092.pdf

  28. http://www.health.gov.za/index.php/component/phocadownload/category/199-antimicrobial-resistancehttp://www.health.gov.za/index.php/component/phocadownload/category/199-antimicrobial-resistance

  29. Communication channels for MAC-AMR http://www.health.gov.za/index.php/component/phocadownload/category/199

  30. Raising Health Professional and Public Awareness of AMR and interventions

  31. Incorporating AS and IPC into the South African Health Calendar • Infection Control Week (health care professionals and general public) • World TB day • Hand washing and cough etiquette World health day Theme: Food safety Flu day/week • World Antibiotic Awareness Week 24th March 24 –30 April 7 April 5th May June 15th Oct 17-23 Oct 1-8 Sept 16-22 Nov 9th Dec • World Immunisation Week • World Hand Hygiene day (health care Professionals) • WHO SAVE LIVES: Clean your hands Campaign • Global Hand washing day • (general public) • Pharmacy • week • World Patient Safety Day

  32. Involvement of (and with) international organisations • WHO Global Action Plan forms template for national plans • GHSA • 5 work packages including lead country for lab strengthening • One of lead countries R&D/Pipeline sub-working group • CDDEP • Technical advisor seconded to NDoH • Collaborative work on mapping and technical support • PHE/Commonwealth Twinning Program • SADC collaborative meeting planned to share experiences and resources towards aiding countries in developing national plans

  33. South Africa as a Hub for AMR Support • Experience and strong leadership at NDoH (HIV, TB, Malaria), WHO (ABR - DG), GHSA (5 work packages) & Twinning Programs • National Public Health Institutes of South Africa (NAPHISA) – NHLS/NICD Surveillance • South African Antibiotic Stewardship Programme – one health, expertise, leadership & training • Clinical trials capability – basic science, therapeutics, diagnostics and vaccinology

  34. Acknowledgements National Dept of Health • Ms Precious Matsoso (DG) • Dr AnbanPillay (DDG) • Gavin Steel • Khadija Jamaloodien • Janine Munsamy • Kim Faure (CDDEP) • Stephanie Berrada (SIAPS) SAASP Co-chairs • Adrian Brink • Moritz van Vuuren All of our Partners

  35. SAASP Working Group Leaders

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