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
PARTNERING FOR THE GOALS
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 the South African Antibiotic Stewardship Program (SAASP) by using our 60-minute Twitter chat to discuss antibiotic resistance along with our other panel experts.
UNDERSTANDING ANTIBIOTIC RESISTANCE
World Antibiotic Awareness Week (#WAAW18) 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.
Gladys Dube – @LiveTalkAfrica
Student and Healthcare Social Media expert for the Zulu community in South Africa.
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 Enrique Castro Sáncheez – Imperial College London – @castrocloud
Enrique is currently combining an Early Career Research Fellowship exploring increased participation of nurses in antimicrobial stewardship decision-making and a position as Lead Research Nurse at the Health Protection Research Unit in AMR and HCAI. He works in the theme “Innovations in behaviour change, technology and patient safety to improve infection prevention and antimicrobial use”.
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 Cassandra Kelly-Cirino – @FINDdx
Dr Cassandra Kelly-Cirino joined FIND in May 2017 and is currently Director of Emerging Threats. She has over 20 years of experience working in Canadian and US public health and private sector settings. Cassandra began her career at the Canadian National Microbiology Laboratory working on emerging infectious diseases, including bacteria, viruses and prions.
In her 10-year tenure at the Wadsworth Center, New York State Department of Health, Cassandra served as the Deputy Director of the Biodefense Laboratory, a heavily regulated and accredited laboratory. During this time Cassandra also completed a PhD in Immunology and Infectious Diseases and developed vaccine and passive immunotherapeutic candidates for anthrax infections. She engaged national and international stakeholders in the development of public health policy for infectious diseases with a focus on emergency response and preparedness, developed novel diagnostic assays for multiple pathogens, and served as a development partner for commercial companies developing novel tools to combat infectious diseases. Most recently, Cassandra served as Vice President, Infectious Diseases with DNA Genotek, a Canadian company known for its sample stabilization and collection technologies. In this role, Cassandra was responsible for multiple initiatives to bring simple collection and stabilization solutions to the global public health and outbreak response fields, including a Tuberculosis product designed specifically for low and middle-income countries.
Dr Cecilia Ferreyra – @FINDdx
Dr Cecilia Ferreyra is a Medical Doctor specialized in Infectious Diseases. Before joining FIND, Cecilia worked in Argentina as an infectious disease specialist and with Médecins Sans Frontière for a period of 14 years. She has worked in different countries such as Kenya, China, Somalia, DRC , South Sudan and Uganda, implementing HIV/TB activities in the field. She also worked as HIV/TB Advisor and Leader of the International MSF ABR Task Force.
In May 2018, Cecilia joined FIND’s AMR team as Medical Officer to support AMR projects that address gaps in the availability and use of diagnostic tests to better identify the cause of fever and guide appropriate use of antimicrobials.
Sarah-Jane Loveday – @FINDdx
Sarah-Jane leads the communications team at FIND. She has over 16 years of experience in healthcare communications, including positions in the private sector and journal publishing. Prior to joining FIND in October 2017, she co-led the healthcare team at Weber Shandwick Geneva, a leading global public relations agency.
Sarah-Jane’s private sector experience spans various communications disciplines including Public Relations, External Scientific Affairs, Global Strategic Marketing and Medical Communications. As well as working in-house at Merck focusing on their neurology portfolio, she has worked as a consultant across a diverse range of disease areas and led account teams for numerous clients including WHO, Celgene, Novartis, GSK Bio, Ipsen and Abbott Diabetes Care.
Prior to working in the pharmaceutical industry, Sarah-Jane began her career in journal publishing and trained as a medical editor. She has extensive experience in all aspects of communications strategy and planning, including public relations, digital engagement, data visualization, medical education and scientific event management.
Sarah-Jane is a Certified Medical Publications Professional. She holds a BSc(Hons) from City University, London (UK) and a master’s degree from Royal Holloway, University of London (UK).
Dr Anna-Leena Lohiniva (WHO) – @AnnaLohiniva
Dr Lohiniva is a cultural anthropologist working alongside the World Health Organisation (WHO) with +15 years’ experience in public health programming in the Eastern Mediterranean Region. The focus of her work is in understanding behaviour and developing behaviour change and public health interventions that are context-specific and culturally compatible. Anna-Leena is also currently piloting behaviour change interventions in several countries in the region to reduce the spread of antimicrobial resistance.
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 Esmita Charani – @e_charani
Esmita is the Senior Lead Pharmacist within the faculty of Medicine at Imperial College London at the NIHR Health Protection Research Unit for Healthcare Associated Infections and Antimicrobial Resistance. She is also a Visiting Researcher at Haukeland University Hospital, Bergen Norway, and adjunct faculty at Amrita Institute of Medical Sciences, Kerala India, where she is involved in helping implement and investigate national antibiotic stewardship programmes. Her doctoral thesis investigated antimicrobial stewardship across India, Norway, France, Burkina Faso and England. She is the co-developer or a Massive Open Online Course on antimicrobial stewardship with the University of Dundee and BSAC. After completing her post-graduate training in Cambridge University Hospitals and ten years of experience as a clinical pharmacist in hospitals, Esmita began her research career. She is the recipient of the RPSGB Galen Pharmacy Research Award for research into antibiotic dosing and obesity. She is an investigator in an NIHR Invention for Innovation award investigating the development and use of a point of care personalised clinical decision support tool for antimicrobial prescribing. In her academic career, the focus of her research has been behaviour change interventions in the field of antimicrobial stewardship and the role of mobile health technologies to influence decision making. She is co-investigator on the ESRC award (2017-2021): Optimising antibiotic use along surgical pathways: addressing antimicrobial resistance and improving clinical outcomes (in England, Scotland, Rwanda, India & South Africa). Esmita completed her Masters (MPharm Hons) in Pharmacy at University College London, her MSc in Infectious Diseases at LSHTM and her PhD from Imperial College London.
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.
Roger Harrison – @roger_manc
Roger is a Senior Lecturer in Public Health as well as a specialist in global workforce capacity building and educating public health workers. Interests include online distance education; public engagement; Antimicrobial Resistance and health professional education.
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).
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
Michelle is a final year Masters in Public Health Pharmacy and Management student who uses social networks for research, dissemination of targeted public health information and to track vaccine-related content for research purposes. Matsangaise has co-authored and published review papers for the South African Pharmaceutical Journal.
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).
Mary Millard – @HAISurvivor
Mary Millard is an e-Patient advocate who lives with chronic Pseudomonas Aeruginosa, a bacterium acquired during a lifesaving procedure in a hospital and is on lifetime antibiotics. Mary is a public speaker on healthcare-acquired infections, antibiotic-resistant pathogens, and infection prevention. She is a retired Licensed Professional Nurse (LPN) and lives in North Carolina USA.
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.
Estelle Onyekachi Mbadiwe – @Onyi_Estelle
Onyekachi Estelle Mbadiwe is a Founding Partner of Ducit Blue Solutions. She is a Pharmacist, with an MSc in Health Policy, Planning & Financing. She has substantial expertise across multiple healthcare institutions in project and change management. She has worked on various projects to improve patient safety and deliver quality in healthcare both in Nigeria and the UK, with a key focus on strategies to combat Antimicrobial Resistance. She is the Country co-ordinator for the Global Antibiotics Resistance Partnership (GARP-Nigeria) project, which supported the Nigeria Centre For Disease Control and tripartite partners across Health, Agriculture and Environment to develop a One-Health Situation Analysis & National Action Plan for combating Antimicrobial Resistance (AMR), in line with the WHO Global action plan. This was submitted to the World Health Assembly in May 2017, with work currently on the way towards implementing the 5 Strategic frameworks. She is also the country coordinator for the Fleming Fund, working on improving the quality of surveillance of Antimicrobial Resistance and Antimicrobial Use. She also supported the Fleming Fund (UK) team, currently the largest fund for AMR as a country coordinator to improve the quality of AMR and Antimicrobial Use in Nigeria.
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