Antimicrobial resistance is the global public health problem. To tackle this problem in Nepal, GTA has been working in this area since 2015 in coordination with the Ministry of Health and Population and technical support from Henry Ford Health System, Global Health Initiative.
Stewardship and Training in Antimicrobial Resistance (STAR), Nepal
STAR, Nepal is engaged in supporting education for health care providers through local and videoconferencing training and CME courses on infectious disease, infection prevention and control, AMR, and AMR stewardship.
Identification of pathogen types and resistance to specific antimicrobial agents within program hospital laboratories (Kathmandu Model, Kirtipur, Pokhara);
Development of antibiograms to document resistance patterns;
Development of guidelines specific to common pathogens in Nepal and available antibiotics. Guidelines include recommended antibiotics for both empiric and definitive diagnoses, renal dosing, IV to PO, and duration of therapies;
Evaluation and assessment of changes after implementation of a post-prescription review and feedback (PPRF) program at project hospitals through documentation of physician prescribing practices and patient outcomes;
Conduct of qualitative interviews and a longitudinal physician survey to identify barriers and facilitators to optimize antibiotic use and acceptance of recommendations and adherence to guidelines;
Conduct of a qualitative community-based assessment of antibiotic prescribing practices among health providers (physicians, nurses, pharmacists) and antibiotic use among consumers;
Conduct of a socio-economic survey with community-based pharmacists to learn more about antibiotic dispensing practices and social and economic barriers and facilitators affecting these practices.
Web-based platform for training to the health care providers on AMR stewardship and IPC
Development and implementation of a physician stewardship champion workshop to support the PPRF program;
Development and implementation of a training-of-trainers (TOT) program for physicians to support sustainable antibiotic stewardship education and training;
An exchange internship program between GTA and HFHS including laboratory procedures and community-based work on water access and associated risk for community-acquired resistant disease;
CME courses on infection control and antibiotic stewardship;
Use of videoconferencing between the Infectious Disease Department at HFHS and program hospital sites to support the implementation of the PPRF program and medical education.
Development and implementation of an adapted PPRF program which meets the specific needs of hospital-based doctors in Kathmandu;
Implementation of physician logbooks to document the use of recommended changes in antibiotic prescribing in the program hospitals. These log books help to determine the effectiveness of the PPRF program, but also include portable versions of the antibiotic guidelines;
Dissemination of information about AMR, stewardship, and PPRF programs and engagement in advocacy to promote programmatic and policy changes which can decrease health risks associated with resistant pathogens.
Conduct a feasibility study of the World Health Organization Toolkit for Hospital-based Antimicrobial Stewardship.