T1: How might we improve awareness and understanding of antimicrobial / antibiotic resistance?
T2: How might we strengthen surveillance and research?
T3: How might we reduce the incidence of infection?
T4: How might we optimise the use of antimicrobial use in human, environment and animal health?
T5: How might we improve investment for vaccines, diagnostics and other interventions that help reduce antimicrobial / antibiotic resistance?
T6: How can citizens participate in the fight against antimicrobial / antibiotic resistance?
Join us for a 60-minute Twitter chat with our panel experts. All stakeholders including doctors, nurses, entrepreneurs, policymakers, patient advocates, academics, pharma, medical educators, students, payers, IT developers, data scientists, civil society, NPO’s, researchers etc. locally and globally are welcome. The transcript will be recorded by Symplur.
Start your answers with T1, T2, T3, T4, T5 or T6 for transcript purposes.
Answer only after the moderator prompts. Questions will be prompted every 10 minutes, but keep answers coming using the relevant T and number. Both panel experts and the public are encouraged to answer.
Use the #hcsmSA hashtag in all your tweets so that you are visible to others in the chat and captured on transcript.
Video Source: World Health Organization
UNDERSTANDING ANTIBIOTIC RESISTANCE
World Antibiotic Awareness Week (WAAW) takes place this year between 12-18 November 2018 and it offers a critical opportunity for communities across the globe from all sectors – health, science, industry, civil society– to raise awareness about the appropriate use of antibiotics. In order to do that, it’s important to understand what antibiotic resistance is. The term antibiotic resistance is a subset of antimicrobial resistance (AMR) as it applies only to bacteria becoming resistant to antibiotics.
Antimicrobial resistance (AMR) is a communicable or infectious disease and widely acknowledged as a global health problem, yet in many parts of the world, its magnitude is still not well understood. Antimicrobial resistance occurs when different microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the drugs used to cure the infections they cause ineffective. Microorganisms that are drug-resistant can spread directly or indirectly, from one person to another as well as through the environment or from animals and contaminated food. The overuse and misuse of antimicrobial drugs in human, animal and environmental health such as antibiotics are one of the major contributors to resistance, alongside poor hygiene, sanitation and infection control practices, policies, public awareness and access to quality, affordable healthcare services.
Antimicrobial resistance as a broader term encompasses antibiotic resistance (Bacteria: eg. Streptococcus), antiviral drug resistance (Virus: eg. HIV/AIDS), antiparasitic drug resistance (Parasites: e.g Malaria) and antifungal drug resistance (Fungi: eg. Candida). In severe circumstances, some of these microorganisms develop resistance to multiple types of drugs which we refer to as multidrug-resistance or with the acronym MDR. Microorganisms that develop resistance to antimicrobial drugs like antibiotics are also sometimes called “superbugs”.
The World Health Organization (WHO) reports that 19,000 people in South Africa were estimated to have developed drug-resistant TB in 2016 alone. Indeed, multidrug-resistant TB (MDR-TB) is South Africa’s biggest AMR problem – one caused by multiple factors, including inadequate diagnostic coverage, medicine stockouts, and patient adherence challenges. But it’s not only TB. Treatments for HIV and STIs, malaria, and gastrointestinal, urinary tract, and respiratory tract infections are all under threat. Bacterial infections that are resistant to multiple drugs are also commonplace in South African hospitals otherwise known as Hospital Acquired Infections (HAIs). People with these drug-resistant infections face longer, more uncomfortable treatment regimens, and have a lower likelihood of survival. Often, it is high-risk and vulnerable populations, including children, pregnant women and people with HIV that suffer the most. 
Infectious diseases remain the leading cause of death in all African countries, responsible for the majority of years of life lost as well as the vast majority of deaths of children under 5 years old.  If antimicrobial drugs like antibiotics no longer work to cure these infectious diseases, the outcome could be catastrophic. Further to this, antimicrobial resistance (AMR) on a global scale is an increasingly serious threat to the gains made in health and economic development and for the attainment of the Sustainable Development Goals (SDGs). 
In May 2015, the World Health Assembly adopted a Global Action Plan to tackle antimicrobial resistance which outlines these five objectives:
- Improve awareness and understanding of antimicrobial resistance through effective communication, education
- Strengthen the knowledge and evidence base through surveillance and research
- Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures
- Optimize the use of antimicrobial medicines in human and animal health
- Develop the economic case for sustainable investment that takes account of the needs of all countries and to
increase investment in new medicines, diagnostic tools, vaccines and other interventions
Since the adoption of the Global Action Plan, each country has been encouraged to develop their own national plans according to their local priorities and available resources.
During this 60-minute Twitter chat, we invite you to share your perspective relating to how African countries can achieve the antimicrobial resistance goals as well as accelerate change so that we don’t face a post-antibiotic era where these miracle drugs can no longer be relied upon to save our lives. The five questions we ask during the session will be modelled around the WHO’s Global Action Plan objectives (See top of the blog for questions).
South African National Antimicrobial Resistance Strategy Framework 2014 – 2019
To read the South African National Antimicrobial Resistance Strategy Framework download the document here.
Africa CDC Framework for Antimicrobial Resistance 2018 – 2023
To read the Africa CDC Framework for Antimicrobial Resistance download the document here.
WHO Global Action Plan on Antimicrobial Resistance
To read the World Health Organisation’s (WHO) Global Action Plan on Antimicrobial Resistance download
the document here.
Healthcare social media (hcsm) hashtags and global communities related to Antibiotic Resistance:
#AntibioticStewardship #superbugs #antibiotic #AntimicrobialResistance #OneHealth #InfectiousDiseases
The chat session is open to everyone to participate, however, our panel experts bring a unique set of perspectives relating to the topic.
Dr Niniola Soleye – @drasatrust
Niniola is the Managing Director of the Dr Ameyo Stella Adadevoh (DRASA) Health Trust, an NGO in Nigeria focused on outbreak preparedness and health system strengthening.
Dr Jay Varma – @DrJayVarma
Jay K. Varma, MD is the Senior Advisor to Africa CDC. Based in Addis Ababa, Ethiopia, Dr Varma provides strategic and technical support for Africa CDC’s programs in surveillance, emergency preparedness and response, information systems, laboratory systems, and workforce development.
Dr Heidi Albert – FindDX – @FINDdx
FIND South Africa is an international nonprofit organisation that enables the development and delivery of diagnostic tests for diseases of poverty. Diagnostic tests guide clinical decision-making. By helping to ensure the use of appropriate treatments, diagnostics improve the efficiency of health care spending and help us to fight antimicrobial resistance by guiding the appropriate use of antibiotics. Diagnostic tests are also the foundation of disease surveillance and elimination.
Dr Walter Fuller – WHO
Dr Diane Ashiru – @DrDianeAshiru
Dr Diane Ashiru-Oredope is the Pharmacist Lead for Antimicrobial Resistance and Stewardship and HCAI at Public Health England and the Department of Health Expert Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI). Diane is also lead for the Antibiotic Guardian Pledge Campaign.
Dr Debbie Goff – @idpharmd
Debbie Goff Pharm.D. is an internationally renowned infectious disease clinical pharmacist who works hand in hand with physicians and pharmacists in hospitals across six continents advocating for the responsible use of antibiotics through antibiotic stewardship.
Dr Egide Haragirimana – @haregide28
Egide is a medical doctor and public health activist from Burundi. He advocates for multiple issues including self-medication which leads to antimicrobial resistance within his self-established organization called Village Health Action. Dr Haragirimana recently represented Burundi at the One Young World conference as a youth advocate and is also the founder of the #hcsmBDI online geographic community.
Dr Sabiha Essack – @EssackSabiha
Professor Essack is the College Dean of Teaching and Learning and Professor in Pharmaceutical Sciences at the University of KwaZulu-Natal (UKZN), a South African Research Chair in Antibiotic Resistance and One Health and a Wellcome Trust Fellow. Her research has been published in numerous journals and has been presented in many national and international conferences.
Dr Adrian Brink – @ABpreservation
Dr Brink is a clinical microbiologist, co-chair of the South African Antibiotic Stewardship Program (SAASP) and an associate professor at the division of Infectious Diseases and HIV Medicine at the University of Cape Town.
Dr Dena van den Bergh – @inspired2leadQH
Dena has spear-headed collaborative efforts in antibiotic stewardship including across multi-hospital systems in South Africa that have been featured in the Wellcome Trust video series “promising pioneers” in stewardship. She is the co-founder of the Best Care Always campaign (www.bestcare.org.za) to reduce infections in public and private hospitals and an honorary lecturer in the division of Infectious Diseases and HIV Medicine at the University of Cape Town.
Dr Marc Mendelson – @SouthAfricanASP
Marc is a Professor of Infectious Diseases at the University of Cape Town and head of the Division of Infectious Diseases and HIV Medicine. He is chair of the South African Ministerial Advisory Committee on Antimicrobial Resistance and co-chair of the South African Antibiotic Stewardship Programme (SAASP). Marc is also the president of the International Society for Infectious Diseases (ISID).
Maha Talaat – WHO
Iyobosa Victor Omoregbee – @iyobosa
Iyobosa Victor Omoregbee majored in Biochemistry from the College of Medicine, the University of Ibadan, Nigeria graduating in 2003. Iyobosa is a firm supporter of the participatory medicine model as well as patient empowerment which he promotes in Nigeria. Iyobosa is also the moderator and founder of the #hcsmNG online geographic community.
Michelle Matsangaise – @MimmieMatsanga
Dr Natalie Schellack – @NSchellack
Acting Head of the Division of Clinical Pharmacy at the Sefako Makgatho Health Sciences University. Special interest in paediatric pharmacy, antimicrobial consumption and pharmacotherapy induced ototoxicity. Advisor to the South African Antibiotic Stewardship Program (SAASP).
Dr Olga Perovic – @PerovicOlga
Olga Perovic is Principal Pathologist at the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at National Institute for Communicable Diseases, a division of NHLS and Lead in Antimicrobial Resistance and Culture Collection; she is Associate Professor at Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Her scope of activities is in the national surveillance for antimicrobial resistance for nosocomial pathogens, she is an expert in reference activities for AMR and antimicrobial susceptibility testing methods and their clinical applications.
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