Protocol for an interdisciplinary cross-sectional study investigating the social, biological and community-level drivers of antimicrobial resistance (AMR): Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA)

IntroductionAntimicrobial resistance (AMR) is a global health threat that requires urgent research using a multidisciplinary approach. The biological drivers of AMR are well understood, but factors related to treatment seeking and the social contexts of antibiotic (AB) use behaviours are less unders...

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Bibliographic Details
Published in:	BMJ open Vol. 11; no. 3; p. e041418
Main Authors:	Asiimwe, Benon B, Kiiru, John, Mshana, Stephen E, Neema, Stella, Keenan, Katherine, Kesby, Mike, Mwanga, Joseph R, Sloan, Derek J, Mmbaga, Blandina T, Smith, V Anne, Gillespie, Stephen H, Lynch, Andy G, Sandeman, Alison, Stelling, John, Elliott, Alison, Aanensen, David M, Kibiki, Gibson E, Sabiiti, Wilber, Holden, Matthew T G
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 08-03-2021 BMJ Publishing Group
Series:	Protocol
Subjects:	Anti-Bacterial Agents - therapeutic use Antibiotics Antimicrobial agents Bacteria Bayes Theorem Behavior Clinics Consortia Content analysis Cross-Sectional Studies Drug resistance Drug Resistance, Bacterial Global Health Humans Interdisciplinary aspects Kenya Laboratories Multiculturalism & pluralism Ontology Pathogens Public health Retrospective Studies Self-medication Social sciences Sociodemographics Tanzania Uganda - epidemiology Urinary tract diseases Urinary tract infections Urogenital system Kenya Uganda Tanzania Africa microbiology social medicine infection control public health urinary tract infections
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Summary:	IntroductionAntimicrobial resistance (AMR) is a global health threat that requires urgent research using a multidisciplinary approach. The biological drivers of AMR are well understood, but factors related to treatment seeking and the social contexts of antibiotic (AB) use behaviours are less understood. Here we describe the Holistic Approach to Unravel Antibacterial Resistance in East Africa, a multicentre consortium that investigates the diverse drivers of drug resistance in urinary tract infections (UTIs) in East Africa.Methods and analysisThis study will take place in Uganda, Kenya and Tanzania. We will conduct geospatial mapping of AB sellers, and conduct mystery client studies and in-depth interviews (IDIs) with drug sellers to investigate AB provision practices. In parallel, we will conduct IDIs with doctors, alongside community focus groups. Clinically diagnosed patients with UTI will be recruited from healthcare centres, provide urine samples and complete a questionnaire capturing retrospective treatment pathways, sociodemographic characteristics, attitudes and knowledge. Bacterial isolates from urine and stool samples will be subject to culture and antibiotic sensitivity testing. Genomic DNA from bacterial isolates will be extracted with a subset being sequenced. A follow-up household interview will be conducted with 1800 UTI-positive patients, where further environmental samples will be collected. A subsample of patients will be interviewed using qualitative tools. Questionnaire data, microbiological analysis and qualitative data will be linked at the individual level. Quantitative data will be analysed using statistical modelling, including Bayesian network analysis, and all forms of qualitative data analysed through iterative thematic content analysis.Ethics and disseminationApprovals have been obtained from all national and local ethical review bodies in East Africa and the UK. Results will be disseminated in communities, with local and global policy stakeholders, and in academic circles. They will have great potential to inform policy, improve clinical practice and build regional pathogen surveillance capacity.
ISSN:	2044-6055 2044-6055
DOI:	10.1136/bmjopen-2020-041418