Efforts to strengthen antimicrobial stewardship preparedness in anticipation of improved access efforts for novel antibiotics in Kenya

Context

In Kenya, 43% of its population lives in poverty and the increasing prevalence of drug-resistant pathogens poses significant challenges. The country recorded 8,500 deaths attributable to AMR and 37,300 deaths associated with AMR in 2019. To address the issue of AMR and maintain the effectiveness of antibiotics while reducing resistance, Antimicrobial Stewardship (AMS) Programmes have widely been recognized as necessary tools for effectively managing antimicrobial usage. However, AMS initiatives in Kenya remain fragmented and confined to a limited number of facilities, and ensuring that the right patient receives the right antibiotic at the right time, after its registration in the market, poses a significant challenge. With the anticipated introduction of new reserve antibiotics in the country, this project aims to establish a comprehensive, evidence-backed framework for strengthening antimicrobial stewardship (AMS) preparedness in tertiary healthcare facilities across the country. By focusing on developing pragmatic and sustainable use pathways for new antibiotics, the project is designed to set the groundwork for minimizing resistance development and enhancing overall healthcare outcomes.

Problem

This project aims to identify the crucial gaps that need to be filled to create an ideal sustainable AMS ecosystem in select healthcare facilities which enables the culture of appropriate use so that such hospitals can become role models for other facilities to use reserve antibiotics responsibly. An investigation into human behavioural complexities involved in the implementation of AMS and economic aspects and the costs of creating the ideal ecosystem is an important part of this research.

Project overview

The goal is to develop a solid, evidence-based understanding of the field situation in tertiary care facilities in Kenya to develop pragmatic optimal & sustainable use pathways for the use of a novel antibiotic (Antibiotic X) with minimum resistance development. Considering the likelihood of new antibiotic introduction in Kenya in the next couple of years, this project contributes to AMS preparedness in the long term.

Specific Objectives:

1.Conduct a situational analysis of:

• current AMS capacities, processes, and capabilities in select HCF
• policy levers to enable stewardship efforts in HCF
• potential to build an economic case and resource generation for AMS scale up in Kenya (representative of LMIC context)

2. Establish an AMS enabling ecosystem by:

• Developing a stakeholder map for AMS uptake and scale up in Kenya that identifies strategic stakeholders and potential strategies for engaging them to improve AMSP in HCF
• Fostering linkages of the HCF leadership team with national authorities (NAP-AMR, National Regulatory Authority etc) to specify the strategic milestones of the TANDEM-ABX roadmap, enable sharing of current AMS activities, organise stakeholder consultations and work together with ICARS and experts to develop tools and standards relevant for AMS integration with country priorities (country buy-in)

3. Develop optimal use clinical protocols and clinical decision pathways through a panel of experts that provide advice for sustainable use of reserve antibiotics (diagnostic stewardship, safety monitoring and active pharmacovigilance) and monitoring of the antimicrobial resistance to it.

4. Develop a case for the social innovation (including- behavioural, policy and economic case) needed to scale up AMS in Kenya.

Outcomes

1. Change in antibiotic prescription practices in select tertiary healthcare facilities in Kenya
2. Develop and implement training and mentorship best practices in AMS for pharmacy, clinicians and intensivists, IPC personel and lab staff to work together for optimal AMS practices
3. Establish the economic costs and behavioural factors to be considered for strengthening AMS capabilities sustainably in critical care facilities of hospitals in Kenya