2 Recommendations

The First National Conference on Antimicrobial Resistance - Promoting Best Antimicrobial Practices in Uganda

By Daisy Winner | 20 Nov, 2016

On November 21st and 22nd in Mbale, Uganda various stakeholders will come together at The First National Conference on Antimicrobial Resistance. The conference will bring together leaders in laboratory sciences, clinical practice, policy makers, veterinary medicine, and pharmacists to examine the problem. Solving antimicrobial resistance will take the collaboration of a multi-disciplinary group of professionals. This conference will focus on finding new and innovative ways to minimize the development of antimicrobial resistance in Uganda.

Over the next two days, two medical students from Busitema University will be sharing live updates from the conference. Stay tuned!

Attached are the conference schedule and abstract book.

Attached resources:

Replies

 

Birikomawa Mathias Replied at 1:18 AM, 21 Nov 2016

Dr. Joseph L. Mpagi gives welcome remarks.

Birikomawa Mathias Replied at 1:56 AM, 21 Nov 2016

Prof. Nelson Sewankambo. President of Uganda National Academy of Sciences (UNAS)
Topic: Perspectives of UNAS
The Antimicrobial Resistance (AMR) burden is of high concern and highly attributed to antimicrobial overuse. In a report released by the Global Antimicrobial Resistance Partnership Uganda (GARP) committee, 100% resistance to Pen G and cotrimoxazole was indicated as well as 50% resistance to vancomycin,clindamycin and imipenem.
Some of the factors as to which ABR was attributed were:
1. The few labs for culture and sensitivity.
2. Inadequate antimicrobial use laws which are weakly enforced
3. The growing concern of ABR in wild animals due to there interface with humans.
4. Inadequate surveillance in hospitals
Some of the recommendations included:
1. Reduction on use of antibiotic use through improved vaccination coverage
2. Improve hospital infection control
3. Reduce ABR in agriculture sector
4. Educate health professionals, policy makers and the public on ABR
5. Ensure political commitment to the ABR threat

Jenifer Lasman Replied at 2:13 AM, 21 Nov 2016

The issue of ANTIMICROBIAL drugs not working is affecting the people of Uganda everyday, due to resistance. Thank you to all members of this joint effort, to come together and discuss this issue and hopefully finding a way we can move forward.
Thank you
Jenifer Lasman MD
Co-chair of conference

Birikomawa Mathias Replied at 2:32 AM, 21 Nov 2016

Dr. Florence C. Najjuka, Dept of Microbiology, Makerere University.
In a survey done at Mayuge district (Uganda) in 2008, out of 304 bacterial isolates from 314 patients , 64% of them were S.aures of which 24% were MRSA.
In Sept 2011- April 2012 in Mulago hospital a study indicated 80% of blood cultures, enterobacteriaceace isolates were resistant to ceftriaxone.
So far no evidence in Uganda to ceftriaxone resistance by N.gonorrhae,however, resistance has been evidenced in France and Japan.
In a 2013 study in Uganda, 79% of inpatients received atleast 1 antibiotic and 39% of inpatients had used atleast 1 antibiotic before hospitalisation.
Through community followup studies, there was presence of MRSA, ESBL on ready to eat fruits in markets.

Birikomawa Mathias Replied at 2:43 AM, 21 Nov 2016

Mr. Bernard. An MDR-TB survivor who did give a testimony on how he survived MDR-TB.
He strongly emphasized on the drug side effects.

Attached resource:

Jostas Mwebembezi Replied at 2:57 AM, 21 Nov 2016

Dear colleagues,

Thank you for the updates

We are developing a program to strengthen lab services in Uganda using technology in specimen transportation and a mobile application for results and records in a bid to reduce turn around time and tracking patients.

Jostas

Jostas Mwebembezi
Founder and Executive Director || Rwenzori Center for Research and Advocacy (RCRA)
Consultant || Manchester Global Foundation UK||
Director of Health and Education || Enabling Support Foundation ||
Facilitator || USAID Learning Lab/RCRA-OVC-WG || Skype: Justus325 || Twitter:@JostasM || P.O.Box 898,Fort-Portal, Uganda, East Africa || www.rcra-uganda.org ||
Tel:+256(0)786-207-767 || Office: +256(0)483-660417 || Mob:+256(0)774-553-595
Fostering innovations saving lives

Birikomawa Mathias Replied at 4:08 AM, 21 Nov 2016

Pontiano Kaleebu, Director MCRU/UVRI Uganda Research Unit on AIDS Deputy Director, Uganda Virus Research Institute.
Topic: Progress on HIV Drug resistance Prevention, Surveillance and Monitoring Program Activities In Uganda.
Currently pre-ART HIV Drug Resistance (HIVDR) prevalence is 5.6% overall with 12.5% prevelance in Kampala (capital city)
High indicators towards resistance in second line HIV drugs.
Currently Uganda has 5-15% transmitted drug resistance most especially in the NRTIs and NNRTIs.
10% pre-treatment HIVDR in the naive children of ~5years, 22% in PMTCT experienced children.
However, Ministry of health has some strategies laid down the include:
1. Assessment of HIVDR indicators at all ART facilities
2. Give feedback to HIV clinics
3. Create an HIVDR report
4. Presentation of statistics at National and International meetings.

Birikomawa Mathias Replied at 4:36 AM, 21 Nov 2016

Dr. Jennifer Lasman Physician lecturer Busitema University
Topic: The face of Antimicrobial resistance
Presented a case of a young girl who was diagnosed with rheumatic heart disease, on doing culture and sensitivity Pseudomonas was resistance to gentamycin and ceftriaxone (some of the most common drugs used & available in government health facilities in Uganda). The Pseudomonas strains were sensitive to Imipenem and Piperacillin tazobactam whose full dose costed a total of 4,752,000 Ugshs (US$ 1,320) which the parents could hardly afford.

Birikomawa Mathias Replied at 5:05 AM, 21 Nov 2016

Prof. Mary J.N Okwakol , Vice Chancellor Busitema University
Antimicrobial resistance surpasses the boundaries of of any one discipline. It is therefore appropriate that this conference has been a collaborative effort between Busitema University, Ministry of Health, Ministry of Agriculture Animal Industry and Fisheries, National Drug Authority, WHO and Uganda National Academy of Sciences.

Birikomawa Mathias Replied at 5:46 AM, 21 Nov 2016

Speech by the guest of Honor, Dr. Moriku joyce,Minister of state for primary healthcare.
Commended the organizers of the conference.
1.Emphasized that the recommendations from this conference will be taken up by the Uganda ministry of health.
2. Emphasized the high prevalence of antimicrobial resistance in Uganda.
3. Requested all the health workers and the general public to have a positive attitude toward cabbing the high prevalence of antimicrobial resistance.
4. Recommended that all the recommendations from this conference should be widely disseminated in order to ensure implementation.
5. Assured organizers and the participants of the government willingness to implement the various recommendations from this conference.

Birikomawa Mathias Replied at 8:38 AM, 21 Nov 2016

Speaker sighted out some of the causes of Antimicrobial resistance (AMR) in the agricultural sector that included:
1. Poor drug dosage by farmers e.g. over dosage.
2. Inadequate labs to carry out investigations.
3. Inadequate knowledge of extension workers on prescription of new drugs.
4. Vaccines are not readily available especially in the country side.
Some of the recommendations were:
1. Taking extension workers for refresher courses so as to boost their knowledge.
2. Decentralization of agricultural services
3. Regular sensitization of farmers on AMR.
4. Strict regulation of drug usage by farmers.

Birikomawa Mathias Replied at 9:16 AM, 21 Nov 2016

Maria Kabaisera, Mubende Regional Referral Hospital (Mubende is a district in central Uganda)
TOPIC: Improving uptake of Anti-malarials adherence to malaria diagnosis in Mubende Regional Referral Hospital (July2014-June 2016)
Test and treat strategy improved on levels of non adherence. This was possible because of teamwork and regular meetings held on antimalarial adherence, despite the poor coordination between Lab and Pharmacy departments.

Birikomawa Mathias Replied at 9:24 AM, 21 Nov 2016

Dr. Julius Kuule,Uganda Malaria research Centre.
Topic: Adherence to test and treat strategy in control of malaria in Naguru hospital (Naguru is in the capital city)
Between Jan 2013-Dec 2014, the number of patients seen in the pediatric and medicine wards gradually reduced because of the strategy despite the challenges which included : High workload, reagent stock out, clinicians mistrust the lab results.

Birikomawa Mathias Replied at 9:39 AM, 21 Nov 2016

Discussant: A medical entomologist
Topic: Bio-efficacy of selected impregnated long lasting insecticidal nets (Permant 2.0 &3.0)) with pyrethroid against resistant Anopheles gambiaes in eastern Uganda.
The composition of Anopheles gambiase was 86.99% in Lira (a northern district) and 87.5% in Soroti (an eastern district).
Permanet 3.0 proved better than permanet 2.0.
Thus a need for annual routine monitoring of insecticide resistance.

Birikomawa Mathias Replied at 9:41 AM, 21 Nov 2016

Topic; HIV/ TB.
Moderator; Dr. Hanna Kibuuka, Executive Director, Makerere University Water Reed Project.
Topic; Snap shot into HIV viral load among pregnant mothers in Uganda.
Presentation by Ms. Agnes Napyo Kaseda, Busitema University faculty of health Sciences.
1. Turn around time for the dry blood sample is so long because only 7 out 8 high volume health facilities act as collection centers for the samples but with inadequate human resource.
2. Many of the midwives in Uganda do not know how to collect dry blood samples for viral Load.
3. Sample collections are only done in the laboratories but not in the mother- baby care centers, creating inaccessibility to many mothers.

Topic; Invitro evaluation of anti- tubercluosis activities of some plants against multi-drug resistance mycobacterium tubercluosis.
Presenter; Kevin Komakech, Makerere University.
Study was carried out on Cassia Nigricans and E. amplexicaulis and the extracts of the two plants exhibited anti- mycobacterial activity. However, the total crude extract of E. amplexicaulis had the highest activity with MIC of 0.78mg/ml for MDR, H37RV and M. bovis as compared to the totalcrude methanolextract of C. nigricans with MIC of 12.5, 6.25 and3.13mg/ml for the three strains respectively. For the aqeous extract, E. amplexicaulis extract,was the most active against H37Rv (MIC=25mg/ml) as compared to C. nigricans extact (MIC=50mg/ml). However, both extracts did not show activity on MDR and M. bovis. Terpenoids, alkaloids, tannins and saopnins were present in both extracts fromboth plants except flavonoids.

Birikomawa Mathias Replied at 9:57 AM, 21 Nov 2016

Topic; A situational analysis of multi-drug Resistance among clinical isolates of staphylococcus aureus in Mbale Regional Referral Hospital.
Presenter; J. Iramoit and J. Lasman, Busitema University.
The study revealed hihest resistance in Trimethoprim/sulfamethoxazole, Ampicillin, Erythromycin and Penicillin G (75, 67, and 51 )% respectively. Linezolid, Imipenem and Vancomycin had existence patterns below five percent.
the prevalence of MRSA was 30% where as that of Inducible Clindamycin resistance was 14.5% of Staphylococcus were multi drug resistant.

Birikomawa Mathias Replied at 9:58 AM, 21 Nov 2016

Topic; Antimicrobial Resistance surveillance In Uganda; Barriers and Recommendations.
Presenter; Nsubuga G. A.
37.5% of health facilities reported the ability to identify and perform susceptibility testing on some priority WHO antimicrobial resistance pathogens. Health workers possessed scanty knowledge on antimicrobial resistance and how the respective data could be generated.
The study also reveal inadequate and poor record keeping tools making record keeping very challenging.

Birikomawa Mathias Replied at 12:40 AM, 22 Nov 2016

Day 2 of The First National Antimicrobial Resistance
THEME: Promoting Beat Antimicrobial Practices in Uganda.
Stay online for the updates

Birikomawa Mathias Replied at 12:43 AM, 22 Nov 2016

Day 2 of The First National Antimicrobial Resistance Conference
THEME: Promoting Best Antimicrobial Practices in Uganda.
Stay online for the updates.
THANK YOU

Jenifer Lasman Replied at 1:04 AM, 22 Nov 2016

We are now on day 2. We just had a wonderful summation of day one. Please see the attached file for a nice review of the first day's talks.
Thank you
Jenifer Lasman

Attached resource:

Birikomawa Mathias Replied at 1:18 AM, 22 Nov 2016

Dr. Nicholas Kaunta, Director Animal Resources, Ministry of Agriculture Animal Industry and Fisheries
TOPIC: Agricultural and Veterinary practices leading to AMR
Uses of antibiotics in animals include therapeutic, prophaylatic and non-therapeutic
Why the overusage? So as to provide steady food supply to the country
Farmers rear large stocks of animals which they treat with single antibiotics all day
In developing countries, 50% of antibiotics are used in humans and the 50% in animals

Birikomawa Mathias Replied at 1:33 AM, 22 Nov 2016

Donna Kusemererwa, Executive Director, National Drug Authority (NDA)
Policy regulation on AMR
Explained the different roles of NDA which included regulation of types of drugs ranging from herbal medicines to the essential drugs, drug registration, banning of unsafe drugs, regulation of drug usage at different levels and regulation of drug promotion.
NDA formed the National Medicines Policy 2015 that provides assessment of essential drugs usage which includes antibiotic use.
Also NDA frequently changes policy in order to promote rational drug use.

Birikomawa Mathias Replied at 1:53 AM, 22 Nov 2016

Henry Kajumbula, Chair, MOH, task force on AMR surveillance
TOPIC: AMR surveillance in Uganda.
One of the major roles the task force is to characterize new resistance patterns.
In 2015/16 Mulago hospital had the highest number of cultures done followed by Lacor hospital (Gulu) then Mbale Regional Referral hospital.
Strategies to tackle AMR include:
1. Have the Integrated Epidemiological Surveillance Department as the H/Q for AMR surveillance
2. Have a reference Lab i.e. CHPL( Central Health Public Laboratory)
3. Select surveillance sites that provide reliable AMR data.
4. Use lab techniques during surveillance
'5. Do supplementary studies/surveys on AMR.
6. Provision of diagnostic stewardship.
7. Improve lab staffing and requirements
8. Do monitoring and evaluation.

Birikomawa Mathias Replied at 2:26 AM, 22 Nov 2016

Questions and comments ?
1. What is the criteria for herbal medicines reaching the market?
2. Why are the pharmacists not available at their stations but rather dispensers?
ans: reason is not clear to NDA
3. Why the gap between clinics and laboratories?
4. Why does Ministry of Health data indicate zero cultures done in Mbarara hospital yet cultures are done in the hospital?
ans: Mbarara hospital lacks a microbiology lab but rather uses Mbarara University microbiology lab.
5. What opportunities are available for the local people receiving AMR data?
6. A proposal for multisectorial approach towards combating AMR?

Travis Bias Replied at 3:20 AM, 22 Nov 2016

"Gentlemen, it is the microbes who will have the last word." - Louis Pasteur

This powerful quote helped open this First National Conference on AMR. Influential speakers from various governmental authorities, academia, and independent think tanks have convened to discuss this critical issue. The United Nations' General Assembly has had only four high-level meetings related to health in the body's history: Ebola Virus Disease, HIV, noncommunicable diseases, and most recently, antimicrobial resistance. Now is the time for us to lead in encouraging and enforcing the rational use antimicrobials.

Birikomawa Mathias Replied at 3:54 AM, 22 Nov 2016

J. Ditai, Sanyu African Research Institute, University of Liverpool
TOPIC: A pilot cluster randomized trial of provision of alcohol hand-gel to postpartum mothers to prevent, neonatal infective morbidity in the home.
Out of 103 preganat mothers from 10 villages around Mbale, 55 babies had presumed infection. (from mother/hospital/positive on screening).
Thus 40% of the babies were exposed to antibiotics most especially ceftriaxone.
On culture and sensitivity, Ceftriaxone, gentamycin and erythromycin showed high rates of resistance.
In conclusion, a baby will have used atleast one antibiotic within 3 months postnatally.

Birikomawa Mathias Replied at 4:08 AM, 22 Nov 2016

Questions?
1. About babygel pilot trial, Did you ruleout the carcinogenic effect of some sanitizes e.g. ethyl alcohol?

Birikomawa Mathias Replied at 4:30 AM, 22 Nov 2016

TOPC: JMS(Joint Medical Stores) contribution in the fight against AMR
A brief description of JMS.
AMR has been accelerated by the irrational drug use.
Roles JMS on AMR:
1. Physico-chemical screening and analysis to detect, intercept and isolate substandard medicines at receipt.
2. Regulate distribution practice in line with good distribution practices.
3. Supplier vetting through prequalification and GDP audits.
4. Capacity building and trained prescribers and dispensers.
5. Active participation in medicine policy formulation.
6. Supply of diagonisitc kIts e.g. RDTs, RPR.
7. Participation in design of treatment guidelines as well as dissemination.
. Provide technical advisories on current trends in health technologies.
Questions:
1. Is there any AMR data present at JMS?
ans: yes it is!
2. Are the diagnostic kits evaluated by higher facilities e.g. NDA?
ans: NDA does qualify some and those that are not evaluated, JMS does screen them vigorously.

Birikomawa Mathias Replied at 5:06 AM, 22 Nov 2016

Discussant: WHO representative.
TOPIC: Global Health Security and International health regulations. What we need to collectively and Africa safe.
~100 public health events annually of which 80% are infectious, 17% are disasters, 3% are chemical. Thus no country is safe.
Uganda has an appreciable response capacity as evidenced with Ebola and Yellow fever.
Thus WHO's strategy is to promptly detect and react towards hazards.
80% of member countries should have a hazard preparedness plan including AMR.
Thus critical indicators to AMR assessment by WHO are:
1. A detection system e.g. laboratories
2. A working surveillance system
3. Stewardship towards combating AMR.

JIMMY ATYERA Replied at 6:12 AM, 22 Nov 2016

Round Table Discussion.
Panelists.
1. Nicolas Kauta, Director Animal Resources, Ministry of Agriculture Animal Industry and Fisheries.
2. Patric Tusiime, Commissioner National Disease Control, Ministry of Health.
3. Donna Kusemererwa, Executive Director, National Drug Authority.
4.Nelso Sewankambo, President of Uganda National Academy of Sciences.
5.Henry Kajumbula, Chair, Ministry of Health Task Force on AMR-Surveillance.
6. Mohammed Lamorade, Principal Investigator, IDI-GHSP Project.
7.Bildard Baguma, Executive Director, Joint Medical Stores.

Discussion question: What and how each of these sectors may contribution to promoting best antimicrobial Practices in Uganda.
Some highlighted points.
1. Having the coordinating Partners and all appropriate contributors work together.
2. Influencing political support as well as support from the ministry of health.
3.Health workers' collaboration in promoting best antimicrobial practices.
4. Adopting the world Health approach.
5. Ensuring better remuneration to the health workers to enure motivation and availability in the health facilities.
6. Improving medical training to ensure that the Medical workers acquire quality knowledge and skills for effective practices.
7. Improving research and development within the country.
8. Stream lining surveillance on best antimicrobial practices.
9. Promoting intersectorial collaboration key to cabbing AMR.
10. Behavioral change in medical field.
11. Enhance community sensitization on antimicrobial use.

JIMMY ATYERA Replied at 7:03 AM, 22 Nov 2016

PLENARY SESSION: 6
MODERATOR: Dr. Crispus Tegu, Department of Head of Paediatrics, Busitema University Faculty Of Health Sciences.
Ongoing.

Birikomawa Mathias Replied at 7:13 AM, 22 Nov 2016

PLENARY SESSION
Adoke Yeka, Makerere University Infectious Disease Collaboration.
TOPIC: Artsunate/Amodiaquine versus artmether/lumefantrine use in treatment of uncomplicated malaria in Uganda
METHODS: We enrolled 602 patients aged 6-59 months from health centers in Apac, Mubende, and Kanungu
Districts in Uganda in 2013-14. Children with uncomplicated falciparum malaria were randomly
assigned treatment with AL or AS/AQ, and 594 (98.7%) of those enrolled were followed for 28
days. Recurrent infections were genotyped to distinguish recrudescence from new infection, and
Plasmodium falciparum resistance-mediating polymorphisms were characterized for all infections.
RESULTS:
The risk of recurrent parasitemia was lower in children treated with AS/AQ, compared to
those treated with AL, at all three sites (overall 28.6% vs. 44.6%, respectively; p <0.001).
Recrudescences were uncommon, but all occurred in the AL treatment arm (0% vs. 2.5%; p =
0.006). Improvement from baseline hemoglobin was greater in the AS/AQ arm (1.73 vs. 1.39 g/
dl, p = 0.04). Both regimens were well tolerated; serious adverse events were uncommon (1.7%
for AS/AQ and 1.0% for AL). Considering new infections after therapy, the two regimens selected
for opposite polymorphisms in pfcrt and pfmdr1, with each drug selecting for polymorphisms
associated with decreased sensitivity to the partner drug. Polymorphisms in the propeller domain of
the K13 gene, which have been associated with artemisinin resistance in Asia, were uncommon and
not associated with recurrent parasitemia.
CONCLUSION AND RECOMMENDATIONS:
Both AL and AS/AQ were highly effcacious, however, overall, AS/AQ showed superior antimalarial
effcacy contrasting with older data and consistent with recent changes in parasite drug sensitivity.
Malaria treatment guidelines should consider multiple or rotating regimens to maintain the effcacies
of leading treatments.

JIMMY ATYERA Replied at 7:21 AM, 22 Nov 2016

Topic: Artesunate/amiodaquine versus artemether/lumefantrine for treatment of uncomplicated malaria in Uganda: A randomized clinical trial at three sites in Uganda.
Presenter; Adoke Yeka, Makerere University Infectious DIsease Research Collaboration.

Background:
With older therapies limited by widespread drug resistance, standard treatment for uncomplicated
falciparum malaria is now artemisinin-based combination therapy, with nearly all endemic countries
in sub-Saharan Africa recommending either artemether/lumefantrine (AL) or artesunate/amodiaquine
(AS/AQ). In Uganda, AL has shown superior efficacy compared to AS/AQ and is the first-line
regimen. However, recent changes in treatment practices and evidence of shifting drug sensitivities
prompted a reassessment of the relative efficacies of these regimens.

Methods:
We enrolled 602 patients aged 6-59 months from health centers in Apac, Mubende, and Kanungu
Districts in Uganda in 2013-14. Children with uncomplicated falciparum malaria were randomly
assigned treatment with AL or AS/AQ, and 594 (98.7%) of those enrolled were followed for 28
days. Recurrent infections were genotyped to distinguish recrudescence from new infection, and
Plasmodium falciparum resistance-mediating polymorphisms were characterized for all infections.
Results:
The risk of recurrent parasitemia was lower in children treated with AS/AQ, compared to
those treated with AL, at all three sites (overall 28.6% vs. 44.6%, respectively; p <0.001).
Recrudescences were uncommon, but all occurred in the AL treatment arm (0% vs. 2.5%; p =
0.006). Improvement from baseline hemoglobin was greater in the AS/AQ arm (1.73 vs. 1.39 g/
dl, p = 0.04). Both regimens were well tolerated; serious adverse events were uncommon (1.7%
for AS/AQ and 1.0% for AL). Considering new infections after therapy, the two regimens selected
for opposite polymorphisms in pfcrt and pfmdr1, with each drug selecting for polymorphisms
associated with decreased sensitivity to the partner drug. Polymorphisms in the propeller domain of
the K13 gene, which have been associated with artemisinin resistance in Asia, were uncommon and
not associated with recurrent parasitemia.

Conclusion And Recommendations:
Both AL and AS/AQ were highly efficacious, however, overall, AS/AQ showed superior antimalarial
efficacy contrasting with older data and consistent with recent changes in parasite drug sensitivity.
Malaria treatment guidelines should consider multiple or rotating regimens to maintain the efficacies of the leading treatment.

Birikomawa Mathias Replied at 7:25 AM, 22 Nov 2016

Ivan Namakoola, MRC/UVRI, Uganda Research Unit on AIDS
TOPIC: From Antiretroviral Therapy Access to provision of Third Line regimens: evidence of HIV Drug Resistance Mutations to first and second line regimens among Ugandan adults.
FINDINGS:
Between July 2013 and August 2014, 953 individuals were enrolled, 119 (12.5%) had HIVRNA≥ 1000 copies/ml and 110 were successfully genotyped; 75 (68.2%) were on frst-line and 35 (31.8%) on second-line ART regimens. The commonest clinically signifcant major resistance mutations associated with the highest levels of reduced susceptibility or virological response to the relevant NRTI were M184V -20.7 %, K65R -8.0%, and thymidine analogue mutations (TAMS); M41L -8% and K70R -8%, while major NNRTI mutations were K103N -19.0%, G190A - 7.0% and Y181C - 6.0%. A relatively nonpolymorphic accessory mutation A98G - 12.0%, was also common. Seven of the 35 patients on second line ART had the most common clinically signifcant PI-resistance mutations associated with the highest levels of phenotypic resistance and/or with the strongest clinical evidence for interfering with successful PI therapy. These were V82A - 7.0%, I54V, M46I, and L33I (all 5.0%). Also common were L10I - 27.0%, L10V -12.0% and L10F-5.0% accessory PI-selected mutations that either reduce PI susceptibility or increase the replication of viruses containing PI-resistance mutations. Of the 7 patients with major PI DRMs, fve had high level resistance to boosted Lopinavir and Atazanavir, with Duranavir as the only susceptible PI tested.
CONCLUSION
In resource-limited settings, HIV care programs that have previously concentrated on ART access, should now consider provision of access to routine HIV viral load monitoring, targeted HIV drug resistance testing and availability of third-line ART regimens.

Birikomawa Mathias Replied at 7:42 AM, 22 Nov 2016

Dr. Paul Kyambadde, Ministry of Health.
TOPIC: Ecology and Environmental drivers to AMR.
Some of the environmental hotspots to AMR include:
1. Effluent from production sites
2. Animal manure from livestock farms
3. Incompletely treated urban sewage
4. Hospital waste.
Resistomes may not be eliminated by water treatment.

Birikomawa Mathias Replied at 8:00 AM, 22 Nov 2016

TOPIC: Changes and issues in antibiotic therapy in UCG (Uganda Clinical Guidlines) 2016
Name: Juliet Kitutu, Appropriate Medicine Use Unit, Pharmacy Division, Ministry of
Health.
The UCG guides health workers on optimal management of priority health conditions. The UCG is updated every 2-3years.
Principles for Antibiotic use:
1. At first line: narrow spectrum oral drugs
2. Few antibiotics in PHC
3. Do culture and sensitivity whenever possible
4. Empirical antibiotics only for use in severe illness with switch from oral to IV within 24hours if necessary.
General recommendations:
1. Cotrimoxazole to be used only Prophylaxis in HIV patients
2. Emphasized to use of ANTIBIOTICS on none bacterial infections.
Sources of information included expert opinions situation analysis 2015. However, a challenge of little data on AMR was faced.

Birikomawa Mathias Replied at 8:13 AM, 22 Nov 2016

QUESTIONS:
1. What is the recommendation for treatment of cerebal malaria?
ans: Treat is similar to that of severe malaria.
2. What is the antibiotic prophylaxis after surgery?
ans: currently no guideline available.
3. What is the recommendation for superimposed infection with bacterial infection in case diagnostic tests are not available?

Birikomawa Mathias Replied at 8:27 AM, 22 Nov 2016

Dr. Joesph L. Mpagi ( Chairperson of the Conference) gives concluding remarks.

Birikomawa Mathias Replied at 8:40 AM, 22 Nov 2016

Prof Julius G. Wandabwa, Head of department Gynecology and Obstetrics, Chief Rapporteur for the National AMR Conference
Gave recommendations from the conference. See attachment below.

Birikomawa Mathias Replied at 8:47 AM, 22 Nov 2016

The Vice Chancellor Busitema University thanked alot all the stake holders, all discussants and all members who have attended.

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.