Can technology play a role towards antibiotic resistance in South Africa?
JOIN THE PUBLIC TWITTER CHAT FOR ANTIBIOTIC GUARDIAN SOUTH AFRICA
Date: 22 November 2019
Time: 19:00 SAST, CAT | 20:00 EAT | 17:00 BST | 13:00 EST | 18:00 CET
Moderator: @hcsmSA (Vanessa Carter)
How to participate
Facebook event reminder
Because partnerships form an integral part of the United Nation’s Sustainable Development Goals Agenda (SDGs) through Goal 17, this month, hcsmSA will be supporting Antibiotic Guardian South Africa using our 60-minute Twitter chat to promote their pledge campaign during World Antibiotic Awareness Week 2019 which takes place between the 18th-24th of November.
Join us for a 60-minute session with our panel experts. All stakeholders locally and globally are welcome. The public transcript will be recorded by Symplur.
T1: What gaps do you think South Africa needs to tackle for Antibiotic Resistance?
T2: What role can the public play towards combating Antibiotic Resistance in South Africa?
T3: What can healthcare professionals do to play a role in tackling Antibiotic Resistance for South Africa?
T4: How do you think technology could make a difference towards Antibiotic Resistance in South Africa?
CT: (Closing Thoughts): Is there anything you feel is important to add to this conversation?
Start your answers with T1, T2, T3, T4 or CT 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 public attendees are encouraged to participate.
Use the #ProtectAntibioticsZA hashtag in all tweets so you are visible to others in the chat.
Can technology play a role in improving Antibiotic Resistance for South Africa?
The story about antibiotics is all too familiar to many of us. As the story goes; in 1928, a scientist called Sir Alexander Fleming accidentally discovered something called penicillin. Fleming was a professor of Bacteriology, (i.e. the study of bacteria which is a branch of Microbiology), and whilst away on vacation, on his return he found mould growing on one of his Petri dishes in his laboratory. In the area where these mould microorganisms (i.e. fungi) were growing, the bacteria had died. What this proved was that the mould was effective at killing the bacteria he was studying to find a cure for. 
After Fleming’s discovery of the first antibiotic which he called penicillin, many more scientists set out to discover their own antibiotics that could target other types of bacteria causing infection. Some of these various antibiotics were named methicillin and oxacillin and were found in nature. But, these antibiotics were only effective at killing bacteria, not against other types of microorganisms like parasites, fungi and viruses. However, people began using antibiotics for every infection, even if they were caused by a different microorganism. This unnecessary overuse of our precious antibiotics began causing the bacteria to adapt so they could survive.  They were becoming resistant to antibiotics.
The first case of penicillin resistance after its discovery by Sir Alexander Fleming was observed in 1947.  Methicillin was then introduced to counter penicillin-resistant bacteria in 1960, however, methicillin-resistant bacteria was soon discovered in a patient in 1962 . Scientists called these evolving bacteria “superbugs”. Over the next few decades new antibiotics were discovered, some were strong enough to kill these emerging “superbugs”, however again due to the overuse of these medicines now not only in human health but in animal and food production too, resistant strains of bacteria started to evolve more rapidly. Antibiotic-resistant strains of bacteria could also be spread to the environment, for example through water sanitation systems as well as between sectors. This became known as One Health, where the health of humans, animals and the environment are recognised as interconnected. In 2016, the UN held a high-level meeting and declared antibiotic resistance as one of the most urgent global health threats facing our world today. Some even referred to it being as complex and serious as climate change because it required the same type of continental co-operation to tackle it.
One of the major diseases caused by bacteria is Tuberculosis (a bacteria called Mycobacterium tuberculosis). With an estimated 19,000 people in South Africa that have developed drug-resistant TB in 2016, multi-drug resistant TB is South Africa’s biggest antibiotic-resistance problem – one caused by multiple factors, including inadequate diagnostic coverage, medicine stockouts, and patient adherence challenges.  Another severe issue is related to hospital-acquired infections (HAIs). HAIs can happen in any healthcare facility both private and public, in a developed or developing country, including in hospitals, ambulatory surgical centres, end-stage renal disease facilities, and long-term care facilities. HAIs can be caused by different microorganisms including bacteria  Common bacterial infections include Clostridium difficile (C. Diff.) infections, urinary tract infections and Sepsis, among many others. Methicillin-resistant Staphylococcus aureus (MRSA) is a common example of a resistant infection caused by a bacteria called Staphylococcus aureus which has become resistant to methicillin and can be acquired in a hospital, however other types of less common resistant bacterial infections like colistin resistance, (Colistin being one of a number of last-resort antibiotics) can also spread in hospitals where bacteria have adapted to these treatments. Antibiotic stewardship in hospitals is critical to managing this and includes teaching the strict practice of infection control so these various bacteria don’t spread between patients as well as improving antibiotic use, monitoring and reporting.
Today, defeating these antibiotic-resistant diseases is a national priority, with the mission of the latest South African Antimicrobial Resistance National Strategy Framework to get our country on track to eliminate them as public health threats by the year 2030 using the One Health approach.
How can technology help us tackle antibiotic resistance in South Africa?
If there was ever a worthy cause for innovative technology, it is saving lives and protecting our antibiotics is doing just that. While some might believe continuously innovating new antibiotics to combat these emerging “superbugs” is the answer, the truth is, the last meaningful antibiotic was discovered 30 years ago.  Some news is emerging around various researchers developing new antibiotics, but most of the larger pharmaceutical companies have stopped investing in research and development. One of the reasons for this is because antibiotics need to be used with scarcity since the overuse of antibiotics leads to resistant bacteria.
Behaviour change is one of the issues that need to take place not only with healthcare professionals but with other stakeholders too, including farmers and patients. These behavioural changes include the more prudent use of antibiotics as well as improved infection control and prevention practices. Policy changes also need to take place globally that consider resistant bacteria crossing borders both in humans as well as in trade and industry. Technology can play a major role in terms of data surveillance which is lacking in all parts of the world but particularly in low-to-middle income countries where health systems are predominantly paper-based.
Artificial Intelligence (AI) is an example of a type of technology that researchers are investing in globally which can be useful in multiple ways, including in diagnostics. Such an example is the “Precision AMR” project currently at UCL which aims to improve tests for antimicrobial resistance and to develop algorithms to rapidly interpret test results.  Point of Care (POC) diagnostics are the ultimate goal because they could help doctors identify what type of microorganism (bacteria, virus, parasite, fungi) is causing an infection before prescribing a course of antibiotics unnecessarily to a patient . A good example of this is when patients have a cold or flu which is caused by a virus and which antibiotics can’t kill. Organisations like the Foundation for Innovative New Diagnostics (FINDdx) are working on this in South Africa already. AI could also help make sense of disease outbreak big data which if pulled together from multiple sources will be huge. It could include bacterial genome sequences, land use, location of specific facilities such as wastewater recycling plants and hospitals, data about antibiotic prescriptions, and infection data, alongside geospatial mapping to link data to its physical location. 
Mobile technologies like smartphones are critical to data generation not only among medical professionals but also for patients who could potentially track their infection progress daily or input other types of data such as that related to antibiotic adherence. Phones are also powerful tools to develop educational resources that empower patients so they can participate better in their own care . Healthcare social media (hcsm) and the web in addition to this are important cost-effective tools to improve mass public awareness as well as monitor the understanding and sentiment about antibiotics on open-access platforms like Twitter through public conversations using social listening tools like Hootsuite, NodeXL and Symplur . Electronic health records (EHR) could further be useful in monitoring the various types of antibiotics prescribed during a patient’s lifetime which should ultimately be able to cross borders if they emigrate, travel or seek out medical care in another country. They could further be used as a tool to improve collaboration and communication between different types of medical experts who are treating a single patient. Some companies in the EU like The Nordic Interoperability Project are already exploring the potential of cross-border medical data that follows the patient (i.e. ePatient).
Innovative new vaccines are also critical so that we can treat infections before they happen, therefore reducing the chance of needing antibiotics for some avoidable diseases. Technology in South African health systems is still a long way ahead, however, without them, trying to truly understand the mechanisms of antibiotic resistance will be difficult to achieve. Our failure to tackle this pandemic locally, like many other countries tackling their own local gaps in antibiotic resistance, would have an impact on our global neighbours. As our health systems are reformed, including in the area of IT and Industry 4.0 which our Honourable President Cyril Rhamaphosa has advocated for , we need to think both locally and globally. How do you think technology could be achieved in South African healthcare for antibiotic resistance?
In this Twitter chat during the World Antibiotic Awareness Week, we bring together various stakeholders working in Antibiotic Resistance to focus on closing gaps in South Africa. Everyone is welcome to join locally and globally. Our transcript will be recorded using the Antibiotic Guardian South Africa official hashtag #ProtectAntibioticsZA on www.symplur.com.
Healthcare social media hashtags and global communities related to Antibiotic Resistance:
#AntibioticResistance #AntimicrobialResistance #AntibioticGuardian #OneHealth #InfectionControl #WAAW2019 #WAAW19
LIST OF PANEL GUESTS
Arlene Brailey – Patient Support Officer at Antibiotic Research UK – @arlenebrailey
Arlene has over 20 years’ experience in postgraduate education and was previously an Assistant Director of NHS Education for Scotland (Pharmacy). She now works with an NPO called Antibiotic Research UK (ANTRUK) as a Patient Support Officer to help identify stories of impact for research and development purposes.
Dr Marietjie Botes – Attorney and Director of Biolawgic – @Marietj72675939
Dr Botes is an attorney specialising in Healthcare and Life Sciences Law and regularly presents on topics such as data sharing and privacy in the context of European and South African privacy legislation. Dr Botes is passionate about genetic, genomic and stem cell research and has published widely on these topics. Her doctoral studies about informed consent for genomic research involving the San populations of southern Africa has won her research awards and resulted in visual communication tools to bridge scientific communication gaps.
Dr Renier Coetzee – University of the Western Cape, ZA – School of Pharmacy – @reniercoetzee
Dr Coetzee obtained a B.Pharm (2002) and M.Pharm (2005) in Pharmacy Practice from the North-West University in Potchefstroom, South Africa. After completing community service in Bloemfontein he worked in various areas of pharmacy, including retail pharmacy, distribution and hospital pharmacy. In 2013 Dr Coetzee completed the Pharm.D programme from Rhodes University in Grahamstown. He joined the School of Pharmacy as a Lecturer in 2013. Dr Coetzee has an interest in pharmacotherapeutics, specifically in the areas of internal medicine and critical care. On an international level he has been involved with the training of Pharm.D students from West Virginia University in Morgantown, USA. In 2013 he was awarded Preceptor of the Year by the West Virginia University School of Pharmacy.
Mary Akangbe – Minimally Invasive Surgery and trained Robotic Assistant – @GlowingFuture
Mary Akangbe is a Specialist Practitioner in Minimally Invasive Surgery and trained Robotic Assistant.
She has a wealth of experience in training, mentoring, capacity building, tele education and health
tech utilizing same in transforming healthcare Globally. She has led and also works within teams on
an innovative approach to healthcare delivery resulting in many ‘First in the Country’.
She is the President/Founder of Zenith Global Health and Zenith Global Healthcare Professional
Awards; a platform for shared learning, skills transfer and collaboration while celebrating the groundbreaking work that healthcare professionals do globally. Mary is a published author and mother to 2 young men who constantly remind her that ‘They are no longer babies’. She has won multiple awards and special mentions for her contributions to
healthcare. Originally from Nigeria, Mary also provides various training and capacity building programs around infection and prevention control across Africa, including South Africa.
Rene Sparks – Clinical Manager at NACOSA and registered nurse – @rene_sparks
Rene Sparks is a Clinical Manager at the Networking HIV/AIDS Community of South Africa (NACOSA), a registered nurse and a Masters in Public Health student. She is passionate about making an impact on South African health and civil society and is involved in various public and private health programmes including primary healthcare training, clinical support and community systems strengthening.
Professor Geoffrey Siwo – Molecular Biologist, Genomics, Artificial Intelligence expert – @gsiwo
Geoffrey’s main interest is in the development of scalable technologies for medical discovery, with a long-term focus on advancing genome medicine, especially in Africa, through computing, open science and discovery-oriented education. He is a scientific co-founder of several projects developing technologies for scalable biological discovery such as DNAge- a computational and DNA sequencing pipeline for predicting human age/aging from body fluids or tissues, Fit2Cure- a computer game that abstracts a fundamental part of drug discovery into a shape fitting game, and, during his PhD, computational methods for predicting drug mechanism of action and potential methods for thwarting drug resistance. Geoffrey is also currently a fellow at the Next Einstein Forum and previously worked as a research scientist at IBM’s Research Lab in Johannesburg.
Blessed Tabvirwa – Senior Programmer at Meditech South Africa – @blestab
Blessed is a Senior Programmer at MEDITECH South Africa and has extensive experience in the IT sector. He started his career as an intern developer/analyst in 2005 at Aerotel and also worked as an IT Support professional for a Pathology laboratory, during which time he designed and developed a custom web-based Lab Management System used for the day-to-day running of the Lab before joining MEDITECH in 2012 where he continues to grow his passion for health technology. Blessed also holds a BSc Honours in Computer Science.
Dr Rendani Manenzhe – SOAR-Regional Lead at GSK | Medical Microbiologist –
Rendani is a Medical Microbiologist and a Clinical Support Manager/ Survey of Antibiotic Resistance Regional Lead at the Department of Infectious Diseases-Antibiotic Resistance at GSK. His interest is in Antimicrobial Resistance and he is currently involved in conducting Antibiotic Surveillance studies in various countries in order to track antibiotic resistance, help develop guidelines, and promote appropriate antibiotic prescription for community-acquired respiratory tract infections.
Dr Atiya Mosam – Public Health Specialist – @atiyamosam
Dr Atiya Mosam is a proudly South African medical doctor. She completed her medical degree in 2007 at the University of the Witwatersrand and worked for the Johannesburg Metro District Health Services at Mofolo Community Health Centre in Soweto before joining the University of the Witwatersrand, School of Public Health as a Public Health Medicine Registrar in 2015. She is currently a Public Health Medicine Specialist who also holds a Masters of Public Health (Policy and Management) and a Masters Of Medicine (Community Health). Atiya holds an interest in healthcare financing and economics as well as health promotion and prevention for non-communicable diseases. She aspires to contribute towards health for all South Africans and her passion for social upliftment extends beyond her career to involvement in numerous projects aimed at increasing awareness of and funding to various causes such as homelessness and HIV-affected youth. She has also served on various Executive Committees, including a role as the Secretary of the Public Health Association of South Africa (PHASA).
Professor Natalie Schellack – Clinical Pharmacy, Sefako Makgatho University @NSchellack
Professor Schellack is the 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).
Professor 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 President of the International Society for Infectious Diseases (ISID), whose flagship emerging and re-emerging infectious diseases communication platform, ProMED-Mail is an internationally recognized, essential One Health resource.
Dr Esmita Charani – @e_charani
Esmita is the research pharmacist at the National Institute of Health Research Health Protection Research Unit (HPRU) in Healthcare-Associated Infections and Antimicrobial Resistance. The HPRU is a partnership between Imperial College London, Public Health England, Cambridge University Veterinary School, the Wellcome Trust Sanger Institute and Imperial College Health Partners North West London Academic Health Science Network. She is also a visiting Researcher at Haukeland University Hospital, Bergen Norway and Amrita Institute of Medical Sciences Kerala, where she is involved in helping implement and research antibiotic stewardship programmes.
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 Goff passionately educates healthcare providers on the risk of prescribing antibiotics “just-in-case” there is an infection. Debbie’s patient outcomes research and publications on antibiotic-resistant “superbugs” has made her one of the global faces of antibiotic stewardship. Her fearless approach and her “nothing is impossible” attitude allows her to help hospitals implement stewardship teams in both the US and around the world. She started an international mentoring program for pharmacists from South African and Nigeria that includes bilateral visits, development of patient-centred research, and ‘paying-it-forward’, allowing mentees to transfer skills to other colleagues. She uses Twitter to engage, educate, learn, and connect with healthcare providers, consumers, and patient advocacy groups on topics related to antibiotics. Her global work allows her to strategically links health care experts from multiple countries together in a joint effort to fight superbugs. Dr Goff is an Infectious Diseases Specialist Pharmacist at The Ohio State University Wexner Medical Center and Clinical Associate Professor in the College of Pharmacy. She leads the research program for the Department of Pharmacy. Dr Goff is a founding member of the OSU Antibiotic Stewardship Program and serves on the OSU One Health Antibiotic Stewardship Committee, a multidisciplinary team of animal and human health, agriculture, and public health experts. She is the 2016 recipient of the OSU Emerging International Outreach and Engagement Award for her work in South Africa
Sonya Kolman – @Sonya-kolman
Sonya Kolman is a clinical pharmacist at the Nelson Mandela Children Hospital ( NMCH) a new paediatric hospital in Johannesburg South Africa Sonya obtained her B.Pharm degree from Wits University in 1990 and an MSc Med in clinical pharmacy from Medunsa University in 1997. Sonya has vast experience in both retail and hospital pharmacy. And has held many positions in both hospital management and hospital procurement. At Nelson Mandela Children Hospital she is responsible for implementing antimicrobial stewardship across the hospital and is the chairperson of the antimicrobial stewardship committee. She also is a member of the Gauteng provincial antimicrobial stewardship committee, a government initiative to promote antimicrobial stewardship into the government hospitals across Gauteng Province in South Africa. In October 2018 she was appointed as an honour lecturer at the University of the Witwatersrand (Wits). Sonya is also national treasurer of the South African Society of Clinical pharmacy ( SASOCP). Sonya participated in the NICU mentoring programme in August 2019 at the Nationwide Children Hospital in Columbus Ohio and is involved with the Inspire project with the CDC and Baragwanath Hospital.
Olga Perovic –
Dr Dena van den Bergh – @inspired2leadQH
Experienced healthcare executive with a demonstrated history of success working in the hospital & health care industry. Skilled in leading large scale change, organisational turnaround, strategy development and execution. Contribution to organisational profit improvement and successful new business development and growth. Empowering and developing leaders and teams. Strong track record of large system change leadership, procurement optimisation, customer service and innovation. IHI Improvement Advisor. Transformational change expertise. Analytical Skills. Clinical and systems research. Antibiotic Stewardship and Antimicrobial Resistance global contributor. Healthcare IT development and implementation. Coaching in leadership and the science of quality improvement. Value-based-care advocate. Track record of leading operational efficiencies and leveraging value. Published author. Executive Board Experience as well as Risk, Remuneration and Quality/Safety Board subcommittees. Strong visionary leader with a Doctor of Engineering focused in Systems Engineering from Warwick University.
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