Jacob S Iramiot Welcome remarks from chair Conference –Dr - PowerPoint Presentation

Slide1

Jacob S IramiotSlide2

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 Slide3

Key Note Address: Prof Nelson SewankamboBackground to UNASRecommendations 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 Slide4

UNAS/GARP Committee commitmentsCreation 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 2017Slide5

Prof. Francis Omaswa: Chancellor Busitema UniversityChaired

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 globeRecommendations from the commission Invest in pandemic preparedness and response - pandemics are quite costly Strengthen public healthAccelerate Research &Diagnostics to counter the threat of infectious Diseases

Strengthen global and regional coordination and capabilities – Increase support for WHO Slide6

Epidemiology of AMR

Dr Florence

Najuka

National AMR Conference

21

st

November 2016

MbaleSlide7

conducted a demographic survey in Mayuge District in 2008High level of resistance for Vancomycin Carbapanamase produces gram negatives on a riseColistin

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 Slide8

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?Slide9

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 onEndured side effects He has been declared MBR TB negative – however still has to undergo monitoring Slide10

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

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 Slide11

An overview of HIV Drug resistance prevention , surveillance and monitoring program activities in UgandaTransmitted 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 Slide12

Dr Monica – use of antibiotics in Uganda: data from SPARS 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 IIprescription 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 committeesMore 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 Slide13

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 Slide14

Opening CeremonyRemarks from Vice Chancellor – Prof Mary J. OkwakolWelcomed 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 AMRRequested the Minster to push the recommendations Slide15

Remarks of Key Note speakerNeed 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 Slide16

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 Slide17

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 Slide18

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 implementSlide19

Presentation - Distribution of Antimicrobial in the public sector and mitigation of AMROperations 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 Slide20

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 Slide21

Issues at hand Vet drug shops main source of drug use information yet not qualified personsNo adequate information on antimicrobial use information at drug shop levelAntibiotics 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 Slide22

Break out sessionErchu 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

sSlide23

Experiences and challenges of antimicrobial susceptibility testing - Sara TeguleHuge 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 eDisconnected data reporting systemsOngoing 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 Slide24

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 challengesSome 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 involvedSlide25

RecommendationsIncrease of extension workers atleast 2 per sub county – given refresher training coursesGovt Recentralize agriculture services Regular

sensitisation

programmes on the use of drugsStrict 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 Slide26

Breakout session - MalariaMaria Kabaisera –

Mubende

Regional

Refereal Hospistal Use of Anitimalarials in outpatient department in Mubende Regional Hospital Period July 2014 – June 2016Study 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 Slide27

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 Slide28

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 Slide29

Dr.Francis Ssali - JCRC:PI resistance pattern among patients evaluated for Third line ART Eligibility in Kampala, UgandaThe 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 ARTThere is a need for wider access to 3rd line ART. Slide30

Antimicrobial Resistance Surveillance in Uganda: Barriers and RecommendationsGodfrey Allan Nsubuga

MMS, MPH, PGDME, BSCQE

Monitoring and Evaluation Specialist

Global Health Security projectSlide31

A cross-sectional study design - 22nd

February, 2016 to 12

th

March, 2016Focus group discussions

Questionnaires

Checklists

Methods

:Slide32

Develop, disseminate AMR surveillance guidelines/plansStrengthen laboratory capacity for microbiologyTrain 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. WHONETRecommendationsSlide33

National Conference on Antimicrobial Resistance (AMR) 21-22nd Nov. 2o16 at Mbale, UgandaTOPIC:NON COMPLIANCE AND ASSOCIATED FACTORS LEADING TO THE PREVALENCE OF MULTI-DRUG RESISTANT TUBERCULOSIS IN UGANDA

Bosco Ssemanda

1

JK. Amoah21.Clinical Instructor, Department of Nursing and Midwifery, Bugema University 2.Dean,School of Health and Natural Sciences, Bugema University PRESENTER: Ssemanda BoscoSlide34

RESEARCH TOPICINVITRO EVALUATION OF ANTI-TUBERCULOSIS ACTIVITY OF SELECTED MEDICINAL PLANTS AGAINST MULTI-DRUG RESISTANT

Mycobacterium tuberculosis

Komakech

Kevin*Slide35

Selection criteriaE. amplexicaulis (Icuru-atino

)

Cassia nigricans

(

ayebi

)Slide36

Antimicrobial Resistance of sexually transmitted diseases in sub-Saharan Africa: a reviewPresenter: Meklit Workneh MD, MPHCo-Authors: Stephen Ian Walimbwa

MD, Morgan Katz MD, MHS, Mohammed

Lamorde

MRCP, PhD, Yukari C Manabe MDInfectious Diseases Research FellowDivision of Infectious DiseasesJohns Hopkins Slide37

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

WomenGonorrhea All specimens collected from FSW included NRNR

Table 1. Summary of studies of sexually transmitted studies in SSA, 2013-2016Slide38

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; 2010-2011Norfloxacin 800mg or Kanyamycin 2g IM x 1Doxycycline/Tetracycline NR Cefixime- 0% (<0.016)Ceftriaxone – 0% (0.003)Ciprofloxacin – 6.1% (4.5% I*) (<0.002)Tibebu et al. Ethiopia; 2006-2012NRNRNR

Ceftriaxone – 28%

Ciprofloxacin – 41%Penicillin – 94% Tetracyclines

– 93%Tsai

et al.United States, Djibouti, Ghana, Kenya, Peru; 2010-2013 NR

NRDjibouti (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; 2008-2009NRNR219, 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) Slide39

SummaryReports of cephalosporin resistance on the continent remain based on the few studies we have availableRates of ciprofloxacin resistance compared to the Leopold et al. 2014 review appear to have increasedMagnitude of the problem remains poorly described Little to no standardization among surveillance studies making comparisons difficultSlide40

A Situational Analysis of Multi-Drug Resistance Among Clinical Isolates of Staphylococcus aureus in Mbale Regional Referral HospitalIramiot Jacob Stanley and Jenifer

LasmanSlide41

ResultsSlide42

Table 1; Antibiotic resistance in MRSA, D test +ve and MDR isolates

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)

Trimetoprim-sulfametoxazole

111 (81.02)

42 (37.84)

17 (15.32)

90 (81.08)