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Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP)

Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP)

Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP): A Fleming Fund Regional Grant Program for Africa

Introduction

Antimicrobial resistance (AMR) has emerged as a grave health and policy issue, and the world is faced with increasing multidrug resistance in common pathogens. Undoubtedly, we are steadily approaching a ‘post-antibiotic’ era, unless global efforts on AMR containment are escalated. The World Health Assembly adopted the Global Action Plan on AMR in 2015 and emphasized a need for global surveillance to strengthen the evidence base on AMR burden and for guiding actions.

The Fleming Fund Regional Grant (Round One) Program, an initiative by the Government of the United Kingdom, aims to expand the volume of historical and current data on Antimicrobial Resistance and Antimicrobial Use (AMU) across Africa and Asia. Other Fleming Fund supported programs include country grants and fellowship schemes.

Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP) is a consortium of partners responsible for the implementation of the Fleming Fund Regional Grant Program in Africa. The grant was awarded to the consortium in December 2018, and the duration of the program is for 18-24 months. The consortium is comprised of seven partners namely African Society for Laboratory Medicine (also the lead grantee), the Center for Disease Dynamics, Economics and Policy (CDDEP), IQVIA, Africa Centers for Disease Control and Prevention, West African Health Organization, the East Central & Southern Africa Health Community (ECSA-HC), and Innovative Support to Emergencies, Diseases and Disasters (InSTEDD).

Along with the other MAAP partners, CDDEP researchers are currently involved in executing the data collection and analysis activities.  CDDEP has guided the consortium on the development of tools for collecting laboratory and clinical data, and will also lead efforts on data analysis. Data visualization will be done via ResistanceMap (ResMap), and the Drug Resistance Index (DRI), a metric that aggregates antibiotic use and resistance into a single measure, will be used to compare antibiotic effectiveness.

Program objectives:    

Objective 1: Developing a plan to collect and present AMR and AMU data

Objective 2: Developing a grading system to rate the level of quality of AMR and AMU data.

Objective 3: Data retrieval activities in countries

Objective 4: Developing an analytical model to be used for each type and grade of data

Objective 5: Analysis of AMR and AMU data in the region

Objective 6: Location and description of samples in existing biorepositories

Objective 7: Conducting advocacy for improved data quality and submission of prospective data

Objective 8: Reporting data at country level in a format useful to local policymakers

Program outcomes:

  1. Generation of facility-specific dashboards (raw and analyzed data)
  2. Recommendations to improve facility capacity and reporting capability
  3. Recommendations to implement sustainable systems for AMR & AMU surveillance at national & regional levels
  4. National and regional reports on the state of AMR & AMU
  5. Evidence generation for policy management

Description of study

The MAAP program intends to collect retrospective data on AMR and AMU from a pre-determined number of public and private sector laboratories and pharmacies. The approach adopted will take advantage of previously established networks between the consortium partners and various in-country networks.

Antimicrobial Susceptibility Test (AST) results for different bug-drug combinations and specimens will help to understand the AMR situation in the countries, as well as identify links between AMR and clinical variables. The pathogens under consideration are restricted to bacteria and fungi. CDDEP researchers have participated in various country workshops on the MAAP study methodology with national stakeholders.

Main conclusions

AMR is one of the biggest threats to global health today. Unfortunately, very little data is currently available on AMR in low- and middle-income countries. It is therefore necessary to initiate efforts and obtain robust information on the extent of the problem.  The current study is expected to consolidate large amounts of AMR and AMU data from the African continent and produce policy-informing evidence.

It is expected that the outcomes of the program will complement other efforts in Africa including Africa Union’s Framework for AMR control, the development of national/continental-wide empirical guidelines for the treatment of infectious diseases, and capacity building for AMR and AMU surveillance in Africa.

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Relevant CDDEP papers

Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, Vlieghe E, Hara GL, Gould IM, Goossens H, Greko C. Antibiotic resistance—the need for global solutions. The Lancet infectious diseases. 2013 Dec 1;13(12):1057-98.

Gelband H, Molly Miller P, Pant S, Gandra S, Levinson J, Barter D, White A, Laxminarayan R. The state of the world’s antibiotics 2015. Wound Healing Southern Africa. 2015 Jan 1;8(2):30-4.

Smith DL, Levin SA, Laxminarayan R. Strategic interactions in multi-institutional epidemics of antibiotic resistance. Proc Natl Acad Sci USA. 2005 Feb 22;102(8):3153-8. PubMed PMID: 15677330; PubMed Central PMCID: PMC549473.

Global Antibiotic Resistance Partnership—Kenya Working Group. 2011. Situation Analysis and Recommendations: Antibiotic Use and Resistance in Kenya, Executive Summary. Washington, DC and New Delhi: Center for Disease Dynamics, Economics & Policy.

Global Antibiotic Resistance Partnership—Tanzania Working Group. 2015. Situation Analysis and Recommendations: Antibiotic Use and Resistance in Tanzania. Washington, DC and New Delhi: Center for Disease Dynamics, Economics & Policy.