Itani, Dana; Singh, Chetan; Knowles, Rebecca; Myers, Jessica; Gautham, Meenakshi; (2023) Designing and Evaluating Complex One Health Interventions: An International Workshop. In: Designing and Evaluating Complex One Health Interventions, 21-24 March 2023, London School of Hygiene and Tropical Medicine. DOI: https://doi.org/10.17037/PUBS.04670646 (Unpublished)
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Abstract
It is crucial to expand the scope of antimicrobial stewardship efforts beyond the hospital setting and large-scale commercial farms to encompass agricultural communities and small farms, that form the backbone of food production in many parts of the world. Agricultural communities are primary stakeholders in antimicrobial resistance (AMR) as they face a dual challenge of having weak health systems with limited access to medical and veterinary services, and experience high levels of antibiotic misuse and overuse in humans and animals. Innovative strategies must be developed to disrupt the cycle of antibiotic misuse and to improve healthcare accessibility in these settings, ultimately contributing to the global fight against AMR. There are a comprehensive set of drivers of antibiotic use in community settings, including economic and infrastructural challenges, the absence of a supportive environment for frontline private sector providers responsible for first contact healthcare and antibiotic provision, the involvement of multiple stakeholders with vested commercial interests throughout the value chain, and the lack of effective regulations. These have been recognized as important contributing factors by a multi-country research consortium at LSHTM, known as ‘AgriAMU’, that seeks to enhance antimicrobial stewardship in community settings. The research group has emphasized the necessity for multi-level, multi-component One Health interventions to enhance stewardship in community settings. The present workshop was conceived of as a platform to explore the design, implementation, and evaluation of such complex and holistic interventions, facilitating knowledge exchange among experts from LSHTM's Antimicrobial Resistance (AMR) Centre, the Centre for Evaluation and researchers from the AgriAMU consortium. The workshop brought together 46 participants from 26 disciplines and 8 countries. It was conducted over 2 days and included a series of presentations covering different types of intervention design approaches and evaluation techniques including implementation research. These were followed by AMR case studies and analyses, and presentations were interspersed with breakout discussions. The range of topics included frameworks to model and rank One Health interventions, comparison of different types of trial designs, the importance of systems approaches and process evaluations, and realist evaluations and evidence synthesis. AMR case studies included using participatory systems mapping to determine targets for AMR interventions, evaluation of mobile phone based clinical decision support tools, AMR policy analysis, investigating implementation through different frameworks, and the characteristics of a large-scale implementation research aimed at improving access and reducing inappropriate antibiotic use in children in five countries.
Item Type | Conference or Workshop Item |
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Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology |
Elements ID | 206064 |