Download - Dr ramanan laxminarayan 2
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Objective
Develop actionable national strategies to address the challenge of antibiotic resistance in four low‐ and middle-income countries § Kenya § India § South Africa § Vietnam
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Specific Aims
• Develop the evidence base for policy action on antibiotic resistance
• Identify policy opportunities where research dissemination, advocacy, and information can have the greatest impact in slowing the development and spread of resistance.
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Steps
• Create country pro"les of baseline resistance, antibiotic use and burden of resistance
• Assess the health and economic consequences of antibiotic resistance
• Develop mathematical models of speci"c approaches to delay emergence of antibiotic resistance
• Constitute GARP National Working Groups
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The need for GARP
§ Two fold problem in low- and middle-income
countries: lack of access AND over use § Much higher infectious disease burden
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Over use AND Lack of access are a problem in LMCs
Based on data obtained under license from IMS Health MIDASª (January 2005-December 2010). IMS Health Incorporated. All rights reserved Source: World Health Organization, 2000
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Kenya
WORLD
India
South Africa
Vietnam
US
Pneumococcal mortality per 100,000 U5 year olds
Pneumococcal mortality rate of under five year olds of GARP countries, US and the world (2000)
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The need for GARP
§ Two fold problem in low- and middle-income
countries: lack of access AND over use § Much higher infectious disease burden
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LMCs have a much higher bacterial disease burden…
Top ten leading causes of deaths in 2008
Source: WHO 2011
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The need for GARP
§ Two fold problem in low- and middle-income
countries: lack of access AND over use § Much higher infectious disease burden § Rising incomes are leading to increased antibiotic
consumption
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Antibiotic use is rising in the retail sector, mostly without prescriptions…
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BRAZIL, RETAIL INDIA, RETAIL VIETNAM, RETAIL NORWAY, RETAIL USA, RETAIL
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Per capita total macrolide use, retail sector, 2005-2010
2005
2006
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2008
2009
2010
Source: Based on data obtained under license from IMS Health MIDAS ™ (January 2005-December 2010); IMS Health Incorporated. All Rights Reserved.
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Hospital antibiotic use is rising along with increasing hospital infections
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VIETNAM, HOSPITAL CHINA, HOSPITAL NORWAY, HOSPITAL USA, HOSPITAL
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Per capita total carbapenem use, hospital sector, 2005-2010
2005
2006
2007
2008
2009
2010
Source: Based on data obtained under license from IMS Health MIDAS ™ (January 1999-December 2010); IMS Health Incorporated. All Rights Reserved.
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The need for GARP
§ Two fold problem in low- and middle-income
countries: lack of access AND over use § Much higher infectious disease burden § Signi"cant "nancial burden on poor families
involved in the substitution to non-"rst line drugs § Unique relationship between food animals and
people
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What we found
• Resistance worsening in all four countries • Growing recognition of challenges of resistance • Low priority given to surveillance for resistance • Lack of attention to health system factors that
drive antibiotic overuse • Poor linkages between animal and human
health sectors in addressing antibiotic use
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GARP Situation Analyses
• Kenya
Kenya India Vietnam South Africa
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GARP Phase 2
• Policy action in four Phase 1 countries • Expansion to at least four more countries • Deploy PneuMOD to address policy questions in
intervention effect size • Improved communication of resistance data
§ ResistanceMap § Resistance Index