Global challenges and opportunities for tackling antimicrobial resistance

This post was written by Sophie Allcock andoriginally posted on the Global Health, Epidemiology and Genomics blog – view more at: http://gheg-journal.co.uk/blog/

Antimicrobial resistance (AMR) is a global public health concern. In 2014, an estimated 700,000 deaths were attributed to AMR globally and it is predicted that by 2050 this number could reach 10 million.[1] Antibiotics have been the cornerstone of many medical interventions, for example surgical interventions, transplants and the treatment of common bacterial infections, for decades. Without effective antibiotics, many medical practices that we now consider to be routine will be jeopardised.

Although there is much global attention to AMR, there is a need to better understand the burden, distribution and determinants of AMR at the population level. Antimicrobial use, appropriate or inappropriate, is a driver of AMR yet there is a lack of specific advice as to which interventions are likely to have the greatest impact on reducing the emergence and spread of AMR in both hospital and community settings.

In our paper “Antimicrobial resistance in human populations: challenges and opportunities”, we argue for the integration of a range of epidemiological approaches, which could help to improve our understanding of the population level factors that may influence the development and spread of AMR. This is important for informing interventions to reducing excess use of antimicrobials, whilst also ensuring that those in need of these treatments have access to them.

One such approach is to use routine clinical data and electronic health records (EHRs) in combination with pathogen surveillance, using techniques such as whole-genome sequencing. This could help to improve our understanding of drug resistance, how it emerges and how it spreads. EHRs could also provide an insight into prescribing practices in general practices and hospitals, and how this could be related to the emergence of drug-resistant infections. Using prospective (or longitudinal) study designs, researchers could explore the real-time development of resistant strains in a given population as well as the factors that may drive resistance.

Other preventative strategies to reduce the burden of AMR include basic hygiene and sanitation practices, waste management and safe food preparation. However, in some low- and middle-income countries (LMICs), conducting these basic practices can be challenging due to human resource constrains and weaker civil and health infrastructures. Furthermore, it is often the case in these countries that more people suffer due to a lack of access to drugs than drug resistance itself.

The suggested research initiatives may help to better understand the burden, distribution and determinants of AMR. These approaches should be combined with improved preventative measures, including vaccinations and good hygiene and sanitation practices to reduce the need for therapy in the first instance, and strategies to reduce excess use of antimicrobials to slow the development of resistance. Furthermore, although AMR is a global problem, we need to consider that the issue differs by county and setting, therefore so must the approach taken to tackle AMR.

Reference:
1. O’Niell J., Tackling Drug-Resistant Infections Globally: Final Report and Recommendations, in The review on antimicrobial resistance. 2016, HM Government and the Wellcome Trust: London.

The paper “Antimicrobial resistance in human populations: challenges and opportunities” by S. Allcock, E. H. Young, M. Holmes, D. Gurdasani, G. Dougan, M. S. Sandhu, L. Solomon and M. E. Török has been published Open Access in Global Health, Epidemiology and Genomics and is available here.

Perspectives on HIV/AIDS and “getting to zero” – via Global Health, Epidemiology and Genomics

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HIV/AIDS is a global killer that affects an estimated 37 million people worldwide.(1) Despite success in reducing the burden of HIV, we are now facing treatment challenges due to resistance and are still without a cure or a vaccine for HIV. These issues must be addressed if we are to realise the goal of “getting to zero” HIV cases and deaths.(2)

Sub-Saharan Africa (SSA) has the highest global burden of HIV, with an estimated 25.8 million adults and children living with the condition. Asia, the Pacific region, Eastern Europe and Central Asia also have a considerable burden of HIV. Of the 1.2 million global AIDS-related deaths in 2014, 790,000 occurred in the SSA region and 240,000 occurred in the Asia and the Pacific region.(1) Thus HIV remains a major cause of ill-health and premature death globally, disproportionately affecting low- and middle-income countries.

Access to antiretroviral therapy (ART) has rapidly increased over the past decade, which has led to a notable decline in HIV associated morbidity and death in SSA. It is also believed that overall HIV incidence has been reduced. However, this is not the case for some high risk groups, such as men who have sex with men, where incidence is thought to be on the rise.(3) Thus, it is important to galvanise education and prevention strategies, particularly targeted to these high risk groups to reduce the number of new HIV cases.

There are currently more than 30 antiretroviral drugs approved for use in the majority of developed countries.(4) The latest therapies have improved efficacy, fewer side effects and are easier to administer. However, despite these improvements, there remain issues surrounding drug-specific side effects and interactions with other drugs. We are still without a cure or a vaccine for HIV and treatment of HIV is further hindered by the emergence of drug-resistant pathogens. The development of novel drugs is therefore central to the continued success of HIV therapy, globally. Several drug strategies have been developed or proposed, including antibody therapies and newer classes of antiretrovirals. A better understanding of biological processes underlying HIV disease progression would facilitate efforts to develop novel HIV treatment strategies. It is clear that combinations of current and novel drugs will be required for effective long-term HIV control.

Surveillance will be instrumental in the identification of new and existing cases of HIV to enable the targeting of treatment and control interventions. Fortunately, we have the tools to rapidly detect cases of HIV at the point of care. HIV rapid diagnostic tests (RDTs) are non-invasive and provide results in less than 30 minutes. Scaling-up the use of RDTs will help to identify new cases of HIV and will be particularly valuable in the detection of hotspots of epidemic infection. However, more sensitive and specific tests are still needed, particularly to detect cases of acute infection.

In order to achieve the target of “getting to zero”,(2) integration of surveillance, case detection and diagnosis, treatment and case management will be essential. In light of ART resistance, it will be evermore crucial to incentivise vaccine development initiatives to prevent establishment of infection in the first instance. New treatment strategies, novel HIV therapeutics and the scaling-up of HIV prevention strategies will also be essential if we are to reduce HIV infections and deaths to zero.

Key references:
1. Joint United Nations Programme on HIV and AIDS (UNAIDS). 14 July 2015. www.unaids.org/sites/default/files/media_asset/MDG6Report_en.pdf.
2. Joint United Nations Programme on HIV/AIDS (UNAIDS). Getting to Zero 2011-2015 Strategy. Geneva, Switzerland, 2010.
3. World Health Organization. Global Update on the Health Sector Response to HIV, 2014. Geneva, Switzerland, 2014.
4. FDA. 2014. Antiretroviral Drugs Used in the Treatment of HIV Infection. (Accessed 22 August 2015) http://www.fda.gov/ForPatients/Illness/HIVAIDS/Treatment/ucm118915.htm.

 

This post was originally posted on the Global Health, Epidemiology and Genomics blog – read more at: http://journals.cambridge.org/gheg

 

Rethinking Mental Health in Latin America – via Global Health, Epidemiology and Genomics

Rethinking Mental Health v02 FINAL

Mental health disorders are a huge burden for health systems, particularly in low and middle income countries. A new research hub based in Sao Paulo and Lima is exploring the opportunity to use technology to tackle these disorders.

In 2010, mental and substance use disorders were responsible for the greatest number of years of life lost to ill health worldwide.(1) In 2012, the World Health Assembly officially recognised the major contribution of mental disorders to the global non-communicable disease burden.(2) It urged member states to develop a coordinated and comprehensive response towards mental health treatment through their health and social sectors. Worldwide a large treatment gap exists for mental health disorders, particularly in low and middle income countries (LMICs). Insufficient financial resources in LMICs results in inadequate numbers of trained personnel, and a high proportion of patients who do not receive care; 76-85% of people with severe mental health conditions do not receive treatment.(3)

The Latin American Treatment and Innovation Network in Mental Health (LATIN-MH) is a regional hub for research and training in mental health, based in Lima (CRONICAS), Sao Paulo, Chicago and London. Its aim is to find innovative solutions to address the treatment gaps that exist in mental health care. Although undoubtedly a difficult challenge, at CRONICAS we believe that to develop sustainable mental health interventions, health systems must adapt to scarce resources and health inequities, effectively building upon the existing context. We see LATIN-MH as a “disruptive innovation”: a new product that transforms and adds to traditional ones. This innovation is driven by three pillars: (i) building capacity to achieve sustainability, (ii) developing strategic interdisciplinary partnerships, and (iii) integrating effective mental health treatment into primary care and community health systems.

LATIN-MH combines the innovative use of task shifting and technology to address the mental health treatment gap. Task shifting at the level of healthcare providers and patients’ self-management has been successfully shown to increase child survival rates and maternal health.(4) Furthermore, the growing implementation of e-health and m-health interventions has played an important role in changing unhealthy habits or lifestyles.(5)

Our research component is centred on assessing the feasibility of using a technologically driven nurse assisted intervention (CONEMO) for people with co-morbid depression and diabetes/hypertension to reduce symptoms of depression. The intervention is a 6-week programme based on behavioural activation, an approach which works by engaging patients in activities that improve their mood. Implementing this smartphone application shifts tasks to nurses and smartphones by taking advantage of the huge mobile phone penetration in the region.(6) This is hugely important in settings where staff shortages exist. At the same time, the project builds research capacity within Peru and Brazil by providing a framework for hands-on mentoring and training for junior investigators who will form part of the new cohort of public health researchers. The success of the intervention is currently being evaluated.

We hope that this model will be sustainable and will help improve the management of mental health in the long-term in order to overcome the barriers preventing us from achieving universal access to mental health care and improved population mental wellbeing.

CRONICAS Center of Excellence in Chronic Diseases, supported by the National Heart, Lung, and Blood Institute’s Global Health Initiative under the contract ‘Global Health Activities in Developing Countries to Combat Non-Communicable Chronic Diseases’.

References
1. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet (London, England). 2013;382(9904):1575-86.
2. WHO (World Health Organisation). The global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. Geneva: WHO, 2012.
3. WHO (World Health Organisation). 10 facts on mental health 2014 [cited 2015]. Available from: http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/.
4. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. The Cochrane database of systematic reviews. 2010(3):Cd004015.
5. WHO (World Health Organisation). mHealth: New horizons for health through mobile technologies: second global survey on eHealth. Geneva: WHO, 2011.
6. GSMA Intelligence. The Mobile Economy; Latin America 2014. London: 2014.

 

This post was originally posted on the Global Health, Epidemiology and Genomics blog – read more at: http://journals.cambridge.org/gheg

Cambridge launch new open access journal – Global Health, Epidemiology and Genomics

GHG blog image - cover

Cambridge unveils new Open Access journal – Global Health, Epidemiology and Genomics (GHEG)

Cambridge University Press is delighted to announce a major new open access journal, Global Health, Epidemiology and Genomics (GHEG), dedicated to publishing and disseminating research that addresses and increases understanding of global and population health issues through the application of population science, genomics and applied technologies.

Global Health, Epidemiology and Genomics is the Press’s second Open Access journal in the field of global health, joining Global Mental Health which launched in 2014. Spanning both non-communicable and communicable diseases, GHEG will specifically integrate epidemiology, genomics and related technological advances in the global health context. Topics relevant to GHEG will include studies, methods and resources relating to global population health, disease aetiology, variation in disease susceptibility, drug resistance and surveillance, health care and health care systems, pharmacogenomics and stratified medicine, as well as the challenges of implementing new developments into clinical practice and the community, globally. In addition to more traditional Original Research and Review Articles, GHEG will support submission of Resources and Analyses that provide a framework for integrating and facilitating genomics and global health studies.

The Editor-in-Chief of GHEG is Dr Manjinder Sandhu, head of the Global Health Group based at the University of Cambridge and the Wellcome Trust Sanger Institute. The international Editorial team includes recognised leaders in global health, epidemiology and genomics from around the world who have taken a lead in shifting attention and action to global health and populations, as well as a wider Editorial Board that will reflect and emphasize the broad scope of the field.

Dr Sandhu said, “I am committed to making GHEG an innovative, engaging and practical resource for the global health research community through which we can publish new scientific research, exchange ideas within and across our related disciplines and share resources to facilitate efforts to increase our understanding of human health and shape effective disease management worldwide.”

Professor Alex Brown, Deputy Director of the South Australia Health & Medical Research Institute (SAHMRI) and one of the journal’s Associate Editors commented, “I am delighted to be involved with GHEG, an exciting venture which recognises the relevance and importance of the work being undertaken in the field of global health, epidemiology and genomics and the widespread benefits to be gained by applying technological advances and innovations to research into population health including within disadvantaged population groups. By facilitating discussion and encouraging the sharing of resources GHEG looks to actively support contributions in these areas.”

Katy Christomanou, Publishing Director for STM Journals at Cambridge University Press, added, “This launch affirms our long-term commitment in the global health field and reflects our strong investment in maintaining and extending our successful presence in this area. We are highly enthusiastic at the prospect of working alongside such an outstanding editorial team.”

Global Health, Epidemiology and Genomics will be hosted on Cambridge’s industry-leading platform, Cambridge Journals Online (CJO). The Journal will benefit from a range of the latest author services including article level usage metrics and Altmetric data. In addition, for articles submitted during 2015 and 2016, Cambridge University Press will waive all article processing charges.

For more information please visit the journal website: journals.cambridge.org/gheg

 

Canadian Journal of Emergency Medicine joins the Cambridge Journals list

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A new partnership between Cambridge University Press and the Canadian Association of Emergency Physicians (CAEP).

From January 2015 the Canadian Journal of Emergency Medicine (CJEM) will join the Cambridge Journals list.

CJEM is a scholarly, peer-reviewed journal, produced specifically for emergency medicine care providers in rural, urban, community, and academic settings. The journal focuses on emergency medicine content relevant to clinical practice, emergency medical services, research, medical education, administration, and continuing professional development and knowledge exchange.

A key development will be the move to an online-only format, and CJEM’s readers and authors will benefit from the additional features available on Cambridge’s electronic platform, Cambridge Journals Online. These include increased usability via mobile and web-optimized sites and state-of-the-art functionality. CJEM will be available in a wide range of different article formats for devices including pdf, html, Kindle, and epub to enhance and optimise article usage. These developments will enhance CJEM’s discoverability, whilst CJEM will continue to adhere to the same high level of peer review and editorial excellence.

Speaking about the decision to partner with Cambridge University Press, Vera Klein, Executive Director, Canadian Association of Emergency Physicians, said “CAEP is very excited to be partnering with Cambridge University Press. It will help take CJEM to new heights as a completely digital publication, but it will also allow the journal to continue its focus on Canadian emergency medicine.”

 

Katy Christomanou, Publishing Director for STM Journals, Cambridge University Press, commented, “There is a strong fit between the CAEP’s aims and our strength in emergency medicine within both our books and journals programmes. Our focus will be on expanding the journal’s reach and impact across the community, realising the journal’s potential to attract a worldwide audience.”

 

View the new journal homepage here.

 

Football focus: A study into preparedness of the health sector in Brazil for the 2014 FIFA World Cup

brazil world cup

This post is taken from the abstract of the paper “Hospital Preparedness in Advance of the 2014 FIFA World Cup in Brazil” published in Prehospital and Disaster Medicine.

Regardless of the capacity of the health care system of the host nation, mass gatherings require special planning and preparedness efforts within the health system. Brazil will host the 2014 Fédération Internationale de Football Association (FIFA) World Cup and the 2016 Olympics. This paper represents the first results from Project ‘‘Prepara Brasil,’’ which is investigating the preparedness of the health sector and pharmaceutical services for these events.

This study was designed to identify the efforts taken to prepare the health sector in Brazil for the FIFA World Cup 2014 event, as well as the 2016 Summer Olympics.

Key informant interviews were conducted with representatives of both the municipality and hospital sectors in each of the 12 host cities where matches will be played. A semi-structured key informant interview guide was developed, with sections for each type of participant. One of each municipality’s reference hospitals was identified and seven additional general hospitals were randomly selected from all of the inpatient facilities in each municipality. The interviewers were instructed to contact a reference hospital, and two of the other hospitals, in the jurisdiction for participation in the study.

Questions were asked about plans for mass-gathering events, the interaction between hospitals and government officials in preparation for the World Cup, and their perceptions of their surge capacity to meet the potential demands generated by the presence of the World Cup events in their municipalities.

In all, 11 representatives of the sampled reference hospitals, and 24 representatives of other general private and public hospitals in the municipalities, were interviewed.

Most of the hospitals had some interaction with government officials in preparation for the World Cup 2014. Approximately one-third (34%) received training activities from the government. Fifty-four percent (54%) of hospitals had no specific plans for communicating with the government or other agencies during the World Cup. Approximately half (51%) had plans for surge capacity during the event, but only 27% had any surge capacity for isolation of potentially infectious patients.

Overall, although there has been mention of a great deal of planning on the part of the government officials for the World Cup 2014, hospital surge to meet the potential increase in demand still falls short.

 

The full paper “Hospital Preparedness in Advance of the 2014 FIFA World Cup in Brazil” can be viewed free of charge for a limited time here.

 

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