UK - Department for Business, Energy and Industrial Strategy
Strategies to reduce the burden of antibiotic resistance in China
Project Data Last Updated: 27/08/2020
IATI Identifier: GB-GOV-13-FUND--Newton-MR_S013717_1
Antimicrobial resistance (AMR) and particularly resistance to antibiotics (ABR) has become one of the most complex public health challenges globally. Estimates have suggested that by 2050 AMR will be responsible for 10 million deaths, of which 4.73 million are in Asia, with an associated reduction of 2% to 3.5% in Gross Domestic Product (GDP) that will cost the world up to 100 trillion USD. Our collaborative research and training programme will bring together international experts at leading universities in China and the UK to tackle antibiotic resistance, the type of AMR that is the most pressing concern for human health. China is estimated to be the second largest consumer of antibiotics in the world, with widespread and often inessential use in both humans and livestock. Widespread consumption leads to antibiotic residues in water and soil that may exacerbate the development and transmission of resistance through organisms and chemicals in the environment. Studies have investigated the epidemiology and pattern of drug-resistant infections in China, but the size of the health and economic burdens caused by ABR on a national level and the role of the environment in the development and transmission of drug resistance are still unclear. Most ABR research in China has focused on specific bacteria in hospital patients, selected food animals, or isolated determinants. Better evidence and broader understanding of environmental, community, economic and health care drivers and burdens of ABR based on a systems perspective that recognises interactions between these areas is urgently needed, as are evaluation tools to measure the effectiveness of different ABR-reducing intervention strategies. Due to a dense population, an intensive livestock breeding industry and massive antibiotic use, Eastern China is a key region for controlling antibiotic use and ABR. Our research aims to bridge these key evidence gaps and strengthen disciplinary and methodological research skills, through a set of closely linked projects that will generate the holistic knowledge which is needed to design, deliver and monitor targeted strategies to limit ABR in China and comparable settings. We will also establish sustainable partnerships with cross-disciplinary research expertise that is currently lacking in China and strengthen capacity in policy-relevant research. Since antibiotic resistant infections and their genetic components spread rapidly through international travel, research into ways of reducing the burden of ABR in China is important not only for populations in China and the wider Asian region, but globally. Through three linked programmes of work based at three leading universities in China, supported by UK academics from a wide range of disciplines, we will: 1. Estimate the economic burden of AMR and determine the cost-effectiveness of potential intervention strategies 2. Design and evaluate a tailored intervention to modify antibiotic prescribing behaviour among health professionals and reduce antibiotic consumption among outpatients 3. Measure human exposure to antibiotics from environmental and livestock sources, estimate their health effects & develop tools for risk assessment and monitoring of environmental exposures to antibiotics and antibiotic-resistant genes 4. Gather evidence on current patterns of antibiotic use and the implementation of ABR-related policies and regulations at local, regional and national levels 5. Produce evidence-based recommendations on optimising antibiotic use, monitoring ABR and assessing the success of strategies to reduce ABR in China 6. Build cross-institutional and international collaborative groups to increase China's research capacity in a range of relevant disciplines and methodologies, as well as in the design and conduct of inter-disciplinary research.Objectives
Our overall objectives for the Partnership Hub are to: 1. Estimate the economic burden of AMR in China and determine the cost-effectiveness of ABR-reducing intervention strategies 2. Design and evaluate a tailored intervention to modify antibiotic prescribing behaviour among health professionals and reduce antibiotic consumption 3. Measure human exposure to antibiotics from direct and indirect (water and food animal) sources, estimate their health effects & develop new tools for risk assessment and monitoring of environmental exposures to antibiotics and antibiotic-resistant genes 4. Assemble evidence on current patterns of antibiotic use and the implementation of ABR-related policies and regulations in China at local, regional and national levels 5. Formulate evidence-based recommendations on optimising antibiotic use, monitoring ABR and assessing the success of strategies to reduce the burden of ABR. 6. Build cross-institutional and cross-national thematic groups to enhance research capacity in key disciplinary, methodological and cross-disciplinary research skills. Our project-specific objectives are: Work Package 1 i. To develop a complex intervention aimed at HPs and patients to reduce antibiotic prescribing for RTIs ii. To investigate possible novel intervention components to reduce self-treatment with antibiotics purchased from pharmacies iii. To evaluate the effectiveness of the intervention through a cluster randomised controlled trial. Work Package 2 i. To comprehensively assess exposure level of humans to antibiotics from multiple sources and evaluate consequences in terms of the multiple health hazards posed ii. To investigate types and abundance of antibiotic resistance genes; assess the effects of antibiotic exposure on resistance genes; and explore possible pathways of transmission of ABR genes among livestock, environment and populations iii. To develop an effective approach for monitoring antibiotic residues and ABR genes in aquatic environments by identifying representative monitoring sites and identifying a set of relevant indicative antibiotics and indicators of ARGs, alongside the development of rapid screening methods iv. To describe the spectrum of antibiotics and usage patterns in representative Chinese populations and livestock, and explore the relationship between use of antibiotics and ABR. v. To assess comprehensive spatiotemporal community-wide public exposure to antibiotics (public intake vs total environmental burden) and resulting ABR using Wastewater-Based Epidemiology (WBE) vi. To understand current policy context relating to antibiotics usage and systems for monitoring ABR; to explore implementation of policies to limit antibiotic use in health, agricultural and environmental sectors; and identify strategies to improve monitoring and optimise antibiotic use. Work Package 3 i. To estimate trends of antibiotic use and the incidence and prevalence of ABR in hospital settings ii. To estimate the mortality, excess length of stay and costs of ABR in hospital settings iii. To estimate economic burden of ABR in China from a societal perspective and investigate the cost effectiveness of different intervention strategies.
|Extending:||UK Research & Innovation|
|Funding:||UK - Department for Business, Energy and Industrial Strategy|
|Implementing:||University of Bristol|
Sectors groups as a percentage of country budgets according to the Development Assistance Committee's classifications.
A comparison across six financial years of forecast spend and the total amount of money spent on the project to date.