Transcript RECAP 1x

Jacob S Iramiot
Welcome remarks from chair Conference –Dr Mpagi
• Welcomed participants to conference and highlighted reason for
conference
• Recognized presence of various stakeholders
• Thanked Young people for attending the conference and wished
everyone fruitful deliberations
Key Note Address: Prof Nelson Sewankambo
• Background to UNAS
Recommendations from (GARP) report
• Uganda should have a national policy involving all stakeholders
• Need for a comprehensive plan - reduce need for antibiotics , vaccination ,
through improve health facility infection control and antibiotic
stewardships
• Reduce antibiotics use in agriculture
• Educate health professionals, policy makers
• Ensure political commitment to meet the threat of antibiotic resistance
• Bring together stakeholders and academic from human and animal
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UNAS/GARP Committee commitments
Creation and share of evidence to support policies
Policies to create awareness about ABR
Revision and use of clinical treatment guidelines
Contribute to the national research agenda on AMR
Engage in National and international collaboration to enhance capacity and
learning
• Share reports on the situation with stakeholders
UNAS/GARP Uganda Way forward
• Using the report, design the National Action Plan for Antimicrobial Resistance
for Uganda
• A consultant has been hired and plan is under development
• Plan will be disseminated in Jan 2017
Prof. Francis Omaswa: Chancellor Busitema University
• Chaired Oversight committee was formed composing of a number of
stakeholders from international and African Continents.
• Committee had a work plan divided into four groups – financing , research
and health systems
• Uganda`s infectious preparedness reported as one of the best on the globe
Recommendations from the commission
• Invest in pandemic preparedness and response - pandemics are quite costly
• Strengthen public health
• Accelerate Research &Diagnostics to counter the threat of infectious Diseases
• Strengthen global and regional coordination and capabilities – Increase
support for WHO
• conducted a demographic survey in Mayuge District in 2008
• High level of resistance for Vancomycin
• Carbapanamase produces gram negatives on a rise
• Colistin Resistance still exists
• How much Medicine is being used - self medication in the
community , medicine sold on the streets
• Acknowledged work by the TB Group in controlling
resistance
Self Reflection
• How much is -How much antimicrobial agents are used in a animal food
production in Uganda? use in Uganda?
• Any records? -Any policy on reporting?
-Any form of reporting?
-How much is consumed in private, public not for profit and public health
care?
-How much from unauthorized sources?
Mr. Bernard Mabonga - Testimony from a survivor – MBR TB
• 2013 – 2014 Started taking antibiotics
• Referred to MRRH having visited a private clinic in Mbale
• There were no drugs at MRRH at first but these became available
later on
• Endured side effects
• He has been declared MBR TB negative – however still has to undergo
monitoring
Prof. Potiaona Kaleebu – Director MRC /UVRI
Uganda Research Unit on HIV/AIDS .
An overview of HIV Drug resistance prevention , surveillance and monitoring
program activities in Uganda
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Pre-therapy HIV Drug Resistance (HIVDR) is on the rise in East AFRICA – 36%
Uganda has reached tipping point in the rates of resistance
HIV Drug plan 2017- 2021 yet to be released
WHO came up with HIV prevention strategy - WHO recommends countries to
develop a public health strategy – goal to minimize emergence of HIV resistance
• Accomplishments ( National HIVDR TWG and 5 year plan , annual reports on HIV
Reports , TWG – consists a multidisciplinary stakeholders)
• Summary of National level performance on HIVDR in Uganda – much low than
the WHO recommendations
An overview of HIV Drug resistance prevention , surveillance and
monitoring program activities in Uganda
• Transmitted drug resistance – below 5% recommendation from WHO. Moderate
in Uganda
• Pretreatment and acquired drug resistance each year – WHO 4.5, 11.6 % which Is
above – indication for change in the strategies for drug resistance
• Children – need to be monitored between children below 18 months
• Dissemination and policy – via feedback to clinics, stakeholder workshops,
presentation at national and international meetings, HIVDR reports, Holds
stakeholder meetings
• Change in new treatments as result of the recommendations (e.g. use of EWI in
HIV Programme monitoring , change in Paedatrics)
• What is missing is the ongoing surveillance in the guidelines
• HIVDR should be part of the National programmes , need for more education,
resources including the global fund
• Acknowledged MOH , CDC , WHO and among other partners
Dr Monica – use of antibiotics in Uganda: data from SPARS
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SPARS – stands for Supervision , Performance , Recognition Strategy
SPARS was adopted in 2012 as national strategy – 3098 facilities enrolled
% cough and cold receiving antibiotic – 64% in 2016
Disaggregation by Level (hospital vs. health centre II – hospitals administer more antibiotics than
HC II
prescription of antibiotics is significant - 50% of patients visiting OPD come with antibiotics
SPARS is an effective intervention to improve prescription practices at lower level
Other committees need to be added at high levels – Medicine and therapeutic committees
More depth analysis needed – how much antibiotics are out there
Recommendations – need to collect and analyze data related t antibiotic consumption and use at
level’
Data collection at different levels is possible at National, and Hospital level
Recommendations
• Central level – development national indicator per antibiotic use
Dr Jennifer Lasman - The Face of Antimicrobial Resistance
– BUFHS
• Presented a story of 17 year old mother who was referred to MRRH
with bacterial endocarditis
• Blood culture revealed Pseudomonas.
• Medication for this case very costly – 4752,00 - 1320 USD
Opening Ceremony
• Remarks from Vice Chancellor – Prof Mary J. Okwakol
• Welcomed participants to the conference and BUFHS
• Special welcome for the Minister to grace the function
• BU established in 2007 – as multicampus university. Six operational
campuses . spet 2013 – BUFHS opened to serve underserved
communities . BUFHS – platform for research in the eastern region
• AMR is global problem that needs to be addressed at National &
international level Congratulated the faculty for the initiative – to
organize the first conference on AMR
• Requested the Minster to push the recommendations
Remarks of Key Note speaker
• Need for implementation of recommendations is vital – instead of relying on
prayers
• How can we have the laboratories in MRRH functional to address health
challenges
• AMR – needs rapid action to ensure that doesn’t escalate like the HIV/AIDS
pandemic
• Uganda should have a national policy to address the AMR . All stakeholders
need to work hand in hand
• Need national leadership , governance and stewardship to ensure a national
policy is in place – requested the Ministry
• Forum for transparency and integrity was launched 2 weeks ago by UNAS
Remarks from Chancellor – Prof Omaswa
• Pandemics are a threat for security
• Uganda faces lapses in the implementation of the policy especially in health
Dr Moriku Joyce - Minster of State in Charge of Primary Care
• Proud and excited to be associate with the mentors in attendance
• Appreciate participants to attend the conference
• Platform for all scientists, academics – bridge the gap among scientists
and policy makers
• AMR – growing threat to global security , global problem cause heavy
economic burdens , not new threats – shaking the modern medicine
• Resistance bacteria – spreading among human and livestock
• Resistance to first line regime on increase – resistance requires 2nd line
therapy
• Antibiotics readily accessible over the counter , drug shop , pharmacy
Dr Moriku Joyce - Minster of State in Charge of Primary Care
Health Success stories as a country
• Immunization at 96% - helped in eliminating most of the challenges such as
meningitis
• Improvement to safe water 73 %
• National AMR action plan has been developed – to be reported during
2017
• Need of research – to develop new drugs, strengthen infection and control,
develop standardized surveillance systems
• Thanked Bu for hosting the first ever AMR conference
• Take advantage and identify role in this partnership
• Appeal – BU should ensure that the conference proceeding are widely
disseminated to ensure value for money
Remarks from District Resident Commissioner
• Welcome to Mbale District
• Thanked organizers for the conference to discuss the challenge in the
national and global challenge
• Thanked guest of honor for sparing time to attend
• Recommendations tend to cease at the conference – every sector to
implement its recommendation . Need for a review of what has been
done and each stakeholder reports back
• Small committee to track the implement
Presentation - Distribution of Antimicrobial in the public
sector and mitigation of AMR
• Operations of the Medical Stores - serve all facilities from HC II –
Referals
• Antimicrobial Distribution (Antiviralss, Antimalarials , antifungals
Difectants, Antibacterials
• Reserved antibacterial with limited treatment options – slightly
expensive
Mitigation and wayforward
• QA - all drugs have to be authorized by the NDA, integrity of stored
medicines ,
• Prevention – storage and distribution, campaign and new vaccines
Distribution of veterinary antimicrobials and mitigation of
AMR - Vincent Kayizzi – National Drug Authority
• Regulation s – made in line with international standards
• Global trends approach – ONE HEALTH APPROACH
• Preserve health and welfare of animals and protect public health –
major goal for regulation drugs
• Good pharmacy practice for distributors , routine quality sampling ,
handle market complaints
• Veterinary Pharmacy distribution chains – manufactures , importers ,
retail pharmacies , class C drug shops stock drugs excluding antibiotics
• Licensing professional qualification is minimum diploma in Animal
husbandry
• 529 registered veterinary Medicine products in Uganda
Issues at hand
• Vet drug shops main source of drug use information yet not qualified
persons
• No adequate information on antimicrobial use information at drug
shop level
• Antibiotics used without prescription
• Misleading advertisement on antibiotics
• No data on vet antimicrobial consumption
• Direct sale to farmers by distributors
• Proposed solutions - sensitization and awareness and Professional
control and ethics
Break out session
• Erchu Sam Richard - Presentations - Guidelines to farmers on the use of acaricides and
other animal drugs in Uganda Ministry of Agriculture Animal Industry Fisheries (MAAIF)
• Tick resistance to acaricides
• 30-40 TICK-BORNE diseases in kiruhura district research 2012
• Finding tick developed resistance all classes of acaricides on the market
• Antimicrobial resistance – lacked by MAAIF
• Surveillance of milk samples (Antimicrobial use and resistance - lab studies conducted
• The National Veterinary Drug policy – need to amend the NDA and authority act
• Guiding principles – proper user , equitable distribution, assurance of importation and
exportation of usage quality drugs
• Farmers – need to prevent diseased , assistance of the veterians, draw up a herd health
plan with Veterarian , use of antimicrobial by veterian
• Producer – isolate sick animals to avoid transfer of diseases, comply with storage of
antimicrobials , address the hygiene , keep adequate records
• MAAIF is committed to implement systems ppropriate s
Experiences and challenges of antimicrobial
susceptibility testing - Sara Tegule
• Huge potential for overuse and misuse of antibiotics in
• No surveillance programme for foodborne antimicrobial resistance in Uganda
• 50 samples of beef were collected btn may and 15 cultured using standard
laboratory methods
• Multiple drug resistance was recorded from the research
Challenges
• Inadequate Lab infrastructure e
• Disconnected data reporting systems
• Ongoing work – bovine fecal samples , chicken fecal samples
• One health approach – should be promoted to generate sectoral data. Engage
multidisciplinary of stakeholders to fight the antimicrobial resistance
Challenges in the use of drugs in to treat animals in
Uganda – Farmers Representative
General observation – drugs are substandard , drugs are not effective
Accessibility of drugs challenges
• licensed drug dealers don’t attend instead use relatives who are not qualified
• Some drug not available in the country side by farmers – to addres challenges
• Some drugs gazatted to be under the control of govt eg FMD - farmers are helpless in case of
an outbreak
Usage challenges
• Lack of proper guidance on use of drugs
• Lack of proper storage in knowledge
• Administration of dosage – leading to drug resistance
• Lack of sensitisation
• Extension workers with no knowledge of the new drugs
• Lack of labs at the district level – farmers have to come to makerere
• Farmers don’t follow professional advice due to the costs involved
Recommendations
• Increase of extension workers atleast 2 per sub county – given
refresher training courses
• Govt Recentralize agriculture services
• Regular sensitisation programmes on the use of drugs
• Strict enforcement of laws that regulate the handling of drugs
• Extension workers be residential at the sub country
• NDA should go to the national level to ensure right drugs are being
sold
Breakout session - Malaria
• Maria Kabaisera – Mubende Regional Refereal Hospistal Use of
Anitimalarials in outpatient department in Mubende Regional
Hospital Period July 2014 – June 2016
• Study done in OPD units lab, OPD , Emergency ,Pharmacy , records ,
stores at Mubende Regional Referral Hospital
• Face to face mentorship- Mentorship can improve performance of
health workers and management of malaria
• challenges – coordination between lab and pharmacy , contradictory
test , staff getting medicine on behalf of the patients without testing
Julius Kuule - Uganda Malaria Research Centre Adherence to the test and treat strategy in the control of
Malaria Naguru Refferal Hospital
• Reasons for not adhering to T & T – workload , stock outs , limited
time to wait for lab results , not enough L, PATIENT FACTOR , demand
by patients
• Malaria testing found to be below 25%
• Recommendations – national evaluation of the Test and Treat strategy
, refresher training for all staff , Routine evaluation of government
polices
Loyce Okedi – Minstry Of Health National Malaria Control
Programme - Bioefficacy Of Selected Synergistically Enhanced
Prytheroid And Prethrioid Only Impregnated Long-Lasting
Insuectictidal Nets Against Pyrethroid Restantce Anopheles
Gambiaense From Eastern Uganda
• Uganda achieved on distribution of permanent nets
• Conclusions - Resistant to most pyrthroids
• Permanent 3.0 performed better than 2.0
• Need for annual monitoring
Recommendations
• Put in place an Integrated Vector Management (IVM) strategy and
implementation guidelines – Ivm STRATEGY is ongoing
Dr.Francis Ssali - JCRC:PI resistance pattern among
patients evaluated for Third line ART Eligibility in
Kampala, Uganda
• The risk for Darunavir resistance increased with the accumulation in
the number of PI mutations
• Timely identification of Individuals failing Secondline ART will
minimize the emergence of resistance to Darunavir, a key drug used
in 3rd line ART
• There is a need for wider access to 3rd line ART.
Antimicrobial Resistance Surveillance in Uganda:
Barriers and Recommendations
Godfrey Allan Nsubuga
MMS, MPH, PGDME, BSCQE
Monitoring and Evaluation Specialist
Global Health Security project
Infectious Diseases Institute
College of Health Sciences, Makerere University, Uganda
Investing In The Future – Impacting Real Lives
Methods:
 A cross-sectional study design 22nd February, 2016 to 12th March, 2016
• Focus group discussions
• Questionnaires
• Checklists
Recommendations
• Develop, disseminate AMR surveillance guidelines/plans
• Strengthen laboratory capacity for microbiology
• Train health workers on AMR surveillance and its importance
• Revise HMIS tools to cater for AMR data elements. Introduce
laboratory surveillance data tools/softwares e.g. WHONET
National Conference on Antimicrobial Resistance
(AMR) 21-22nd Nov. 2o16 at Mbale, Uganda
TOPIC:
NON COMPLIANCE AND ASSOCIATED FACTORS
LEADING TO THE PREVALENCE OF MULTI-DRUG
RESISTANT TUBERCULOSIS IN UGANDA
Bosco Ssemanda1 JK. Amoah2
1.Clinical Instructor, Department of Nursing and Midwifery, Bugema
University 2.Dean,School of Health and Natural Sciences, Bugema
University
PRESENTER: Ssemanda Bosco
RESEARCH TOPIC
INVITRO EVALUATION OF ANTI-TUBERCULOSIS
ACTIVITY OF SELECTED MEDICINAL PLANTS
AGAINST MULTI-DRUG RESISTANT
Mycobacterium tuberculosis
Komakech Kevin*
Selection criteria
E. amplexicaulis (Icuru-atino)
Cassia nigricans (ayebi)
Antimicrobial Resistance of
sexually transmitted diseases in
sub-Saharan Africa: a review
Presenter: Meklit Workneh MD, MPH
Co-Authors: Stephen Ian Walimbwa MD, Morgan Katz MD, MHS, Mohammed Lamorde MRCP, PhD, Yukari C Manabe MD
Infectious Diseases Research Fellow
Division of Infectious Diseases
Johns Hopkins
Table 1. Summary of studies of sexually transmitted studies in SSA, 2013-2016
Study
Location;
Study
dates
Gender (Men,
Women, Both)
Clinical
Syndrome
Clinical
Inclusion
Criteria
Sx Reported
Proportion of Abx
use prior to
presentation
Hailemariam et al.
Ethiopia;
2010-2011
Women
Gonorrhea
Urethritis, pain during
sexual intercourse,
vaginal discharge, sx of
PID
Discharge, pain,
urethritis, Sx of PID
0%
Kouegnigan et al.
Gabon; 2009
Both
Genital Mycoplasma
NR
NR
NR
Takuva et al.
Zimbabwe; 2010-2011
Gonorrhea
Visible urethral
discharge
Discharge
21.5%
Tibebu et al.
Ethiopia; 2006-2012
Both
Gonorrhea
NR
NR
NR
Tsai et al.
United States, Djibouti, Ghana,
Kenya, Peru; 2010-2013
Both
Gonorrhea
None
NR
NR
Vandepitte et al.
Uganda; 2008-2009
Women
Gonorrhea
All specimens collected
from FSW included
NR
NR
Study
Location;
Study
dates
Primary Treatment
Used
Second Antibiotic
Used with Dual
Therapy
Positivity Rate (n,%)
Prevalence of Resistance to Antibiotics
Hailemariam
et al.
Ethiopia;
2010-2011
NR
NR
11
5.1%
Cefixime – 0%
Ceftriaxone – 0%
Ciprofloxacin- 18%
Penicillin – 82%
Tetracyclines – 55%
Kouegnigan
et al.
Gabon; 2009
NR
NR
N. gonorrhoeae
(106; 82.8%), C.
trachomatis (15;
11.7%), M.
genitalium (6;
4.7%), T. vaginalis
(2; 1.6%).
Azithromycin
U.urealyticum (192/29.5%),M.hominis (7/53.8%), mixed infection
(91/72.8%)
Ciprofloxacin
U.urealyticum (295/45.4%), M.hominis (1/7.7%), mixed infection (76/61.3%)
Tetracyclines
U.urealyticum (190/29.2%), M.hominis (6/46.1%), mixed infection (65/52%)
Takuva et al.
Zimbabwe;
2010-2011
Norfloxacin 800mg or
Kanyamycin 2g IM x 1
Doxycycline
/Tetracycline
NR
Cefixime- 0% (<0.016)
Ceftriaxone – 0% (0.003)
Ciprofloxacin – 6.1% (4.5% I*) (<0.002)
Tibebu et al.
Ethiopia; 20062012
NR
NR
NR
Ceftriaxone – 28%
Ciprofloxacin – 41%
Penicillin – 94%
Tetracyclines – 93%
Tsai et al.
United States,
Djibouti, Ghana,
Kenya, Peru;
2010-2013
NR
NR
Djibouti (38/23%)
Ghana (6/5%)
Kenya (33/38%)
Ceftriaxone - Djibouti – 13%, Ghana – 0%, Kenya – 0%
Azithromycin - Djibouti – 0%, Ghana – 50%, Kenya – 0%
Ciprofloxacin - Djibouti – 13%, Ghana – 100%, Kenya – 33%
Penicillin- Djibouti – 100%, Ghana – 100%, Kenya – 0%
Tetracyclines - Djibouti - 88%, Ghana – 100%, Kenya – 100%
Vandepitte
et al.
Uganda; 20082009
NR
NR
219, 21.3%
Cefixime – 0.7% (<0.016)
Ceftriaxone - 0% (0.008)
Azithromycin – 2.7% (0.094)
Ciprofloxacin – 83% (2)
Penicillin – 68.2% (32)
Tetracyclines – 97.3% (8)
Summary
• Reports of cephalosporin resistance on the continent remain based
on the few studies we have available
• Rates of ciprofloxacin resistance compared to the Leopold et al. 2014
review appear to have increased
• Magnitude of the problem remains poorly described
• Little to no standardization among surveillance studies making
comparisons difficult
Iramiot Jacob Stanley and Jenifer Lasman
Antibiotics
Resistance (%)
MRSA (%)
D test +ve (%)
MDR (%)
Penicillin G
79 (57.66)
38 (48.10)
14 (17.72)
73 (92.41)
Ampicillin
102 (74.45)
43 (42.16)
20 (19.61)
94 (92.16)
Gentamicin
55 (40.15)
38 (69.01)
9 (16.36)
55 (100)
Ceftriaxone
72 (52.55)
38 (52.78)
15 (20.83)
70 (97.22)
Nitrofurantoin
9 (6.57)
7 (77.78)
1 (11.11)
7 (77.78)
Clindamycin
16 (11.68)
10 (62.50)
0 (0.00)
15 (93.75)
Erythromycin
89 (64.96)
42 (47.19)
19 (21.35)
80 (89.89)
Linezolid
4 (2.92)
3 (75.00)
0 (0.00)
4 (100)
Imipenem
7 (5.11)
7 (100)
2 (28.57)
7 (100)
Vancomycin
4 (2. 92)
2 (50.00)
0 (0.00)
4 (100)
Cefoxitin
48 (35.04)
48 (35.04)
8 (16.67)
48 (100)
Trimetoprimsulfametoxazole
111 (81.02)
42 (37.84)
17 (15.32)
90 (81.08)