Antimicrobial resistance (AMR) is a significant and escalating global health challenge, with low-and-middle-income countries (LMICs) carrying the heaviest burden. The problem is further exacerbated by the limited availability of new, last resort, or reserve antibiotics (such as Antibiotic-X). These reserve antibiotics are critical medicines that must be used with caution to prevent misuse and the development of resistance, which can result in untreatable infections.
In January 2024, with the support of a planning grant from the Novo Nordisk Foundation, ICARS began working with local partners to develop an approach for strengthening antimicrobial stewardship capacities in LMICs for reserve antibiotics (Antibiotic X) – the TANDEM-ABX framework. By strengthening health systems, it aims to ensure equitable and sustainable access to antibiotics for those who need them most, while preventing their misuse and preserving their effectiveness. For this project, India and Kenya are the representative settings chosen for shaping the TANDEM-ABX framework, as both countries are actively implementing their National Action Plans on AMR.
“The Tandem ABX has activated both strong scientific and health system competencies. It was great to see the strong commitment to rethink Antimicrobial Stewardship from ICARS’ partners in both Kenya and India”, Dr Nadia Boisen, Scientific Manager, Infectious Diseases NNF.
Step-wise approach – Local stakeholder consultations (India and Kenya)
The Kenya-based team included local subject matter experts and the Aga Khan University Hospital in Nairobi, while the team in India included local AMS experts, as well as CMC Vellore and the Indian School of Business (ISB), which are undertaking AMR mitigation research projects in the country. Working with local partners in both countries, ICARS undertook a scoping review of existing approaches to strengthen stewardship for reserve antibiotics and a landscape analysis of the different stakeholders working to mitigate AMR in India and Kenya. Following this, stakeholder consultations were held to gather insights from local experts on the proposed TANDEM-ABX framework in Kenya (November 2024) and in India (November and December 2024). The extensive discussions reinforced support for the concept of TANDEM-ABX and provided valuable feedback from local stakeholders to shape it further.
Global TANDEM-ABX stakeholder consultation in Copenhagen
The Global Stakeholder Consultation aimed to further refine the TANDEM-ABX framework, by bringing AMR stakeholders working on access and stewardship in LMICs with key local stakeholders from India and Kenya, representing both public and private sectors. This platform facilitated collaboration, fostering dialogue on access and stewardship while exploring the framework’s value and development approach.
“The meeting brought together diverse perspectives from experts and policy makers from LMICs on one end and from various global agencies and think tanks on the other. The overall consensus was that the time is ripe for piloting novel interventions that link procurement of novel, last resort antibiotics with demonstrable stewardship practices of health facilities in LMICs,” Dr Sarang Deo, Professor Operations Management, Indian School of Business (ISB).
The key objectives of the workshop were to:
- Provide an overview of the TANDEM-ABX project, including the preparatory activities conducted in Kenya and India, with insights and perspectives from country stakeholders.
- Discuss global innovations and strategies for conserving reserve antibiotics, incorporating perspectives from other global AMR stakeholders.
- Develop actionable recommendations for enhancing the TANDEM-ABX framework, ensuring alignment with regional needs and practical implementation pathways based on stakeholder feedback.
The meeting participants included TANDEM-ABX collaborators from Kenya (Aga Khan University Hospital, Nairobi), India (Indian School of Business and CMC Vellore), as well as representatives from the Ministry of Health, Kenya (Department of Patient Safety and AMR and the Health Products and Technologies Unit), and the State Department of Health and Family Welfare from Kerala and Punjab in India. Leading AMR experts from PGI Chandigarh, the AMR advisory group in Telangana, India, and South Africa also attended.
“This workshop is the culmination of ICARS’ efforts in this phase to bring together global AMR stakeholders, both individual experts and leading organizations together with the key stakeholders in India and Kenya to provide critical insights in shaping the TANDEM-ABX framework, which ICARS aims to pilot in the field during the next phase of the project.” Dr Jyoti Joshi, Senior Science Advisor, ICARS,
Global AMR stakeholders working on access and stewardship also participated, including the WHO Global coordination unit, Global Antibiotic and GARDP, CeBIL, CARB-X, CAMO-Net, Africa CDC, Aranda, and FIDSSA. The two-day meeting included presentations and interactive panel discussions on Day 1 and group work on Day 2 facilitated by ICARS and local TANDEM-ABX team members.
Key highlights from the meeting
- Strong interest in a collaborative approach that includes public, private, and faith-based hospitals to strengthen AMS capacity in India and Kenya.
- Recognition of the need for diverse approaches to strengthening AMS in LMICs, ensuring a range of options for different types of health facilities.
- Emphasis on engaging local and global AMR stakeholders to advocate for, explore, and develop innovations that support a seamlessly integrated access and stewardship-based network, ensuring the appropriate use of reserve antibiotics in LMICs.
- A call for more real-world data from LMICs to inform the strengthening and scaling up of AMS capacity
This consultation marked an important step in advancing the TANDEM-ABX framework, reinforcing the commitment of global and local stakeholders to improving access to and stewardship of reserve antibiotics in LMICs.
“A highly inspiring and thought-provoking deep dive into AMS challenges in LMICs like Kenya, with a broad range of stakeholders. It was a great experience and with the support of the government and global AMS experts, I look forward to the next steps,” Revathi Gunturu, Prof & Head Microbiology, Aga Khan University Hospital, Nairobi (AKUHN)
Photo credits: Jamil Ghafuri.