Uganda Antimicrobial Resistance Surveillance Plan 2017 - 2022 Kajumbula Henry Chair AMR Surveillance Taskforce

AMR Surveillance Central to Plans to Combat AMR Strengthen the knowledge and evidence base through surveillance and research Awareness and understanding of AMR – Effective communication, education and training Develop the economic case for sustainable investment: New medicines, diagnostic tools, vaccines and other interventions Optimize the use of antimicrobial medicines in human and animal health. Reduce incidence of infection through effective sanitation, hygiene and infection prevention measures Located at the Equator and in the tropics

Roles of AMR Surveillance Lots of tropical rain forests and wildlife impact on overall health

World AMR Surveillance situation : There is a general lack of surveillance data (particularly for antibiotic resistance) in many parts of the world

Uganda National AMR Surveillance Plan Uganda has developed a plan for AMR Surveillance 2017/2021

World Health Organization 27 June, 2018 WHO launched the Global antimicrobial resistance surveillance system (GLASS) Oct 2015 WHO launched the Global AMR Surveillance System (GLASS)

Development of AMR Surveillance plan for Uganda October 2015 DGHS appointed a taskforce to develop a plan for AMR surveillance The taskforce developed a draft plan based on GLASS and submitted it to the DGHS in September 2016

AMR Surveillance Taskforce Dr. Kajumbula Henry Mr. Lalli William Prof Denis Byarugaba Mr. Obua Thomas Ocwa Mr Gaspard Guma Mr. Wejuli Alfred Mayende - Mr. AISU Steven Dr. Mwangi Christina Dr. Florence Tugumisirize Mr Stefano Tugume Mr Richard Walwema Ms Hellen Ndagije Dr. Robert Downing Mr. Richard Walwema Mr Sam Lubwama Dr. Muhamed Larmorde Prof. Herbert Nsanze Dr. Franklin Kizito Mr. LL Kerchan Dr. Christine Kihembo Mr. Wewendru Izale

Objectives of the Uganda AMR Surveillance Plan To estimate the extent and burden of AMR in human/zoonotic pathogens in Uganda To analyze and report Uganda data on AMR on a regular basis, To detect emerging AMR in Uganda, To inform the implementation of targeted prevention and control measures, To assess the impact of interventions.

Plan outlines 7 strategic approaches National Leadership & Coordination of AMR surveillance Selecting surveillance sites that shall provide reliable, representative data Strengthening laboratory capacity for AMR surveillance Strengthening data collection and management

Plan outlines 7 strategic approaches Strengthening the human resource capacity for AMR surveillance Resource Mobilization and Financing for AMR Monitoring and Evaluation (M&E) Plan and a reporting and data-sharing system for AMR surveillance

National Leadership & Coordination of AMR surveillance The Surveillance Sub-committee of the Uganda National Antimicrobial Resistance Committee Coordination centers for AMR surveillance based on the pathogens Bacterial/ fungal – UNHLS HIV – UVRI Malaria – UMCP Tuberculosis – NTLP

National Leadership & Coordination of AMR surveillance National Reference laboratories: Tuberculosis – NTRL Malaria – UNHLS (Mak CHS Malaria Research Laboratory as a backup) Bacteriology & Mycology – UNHLS (Mak CHS & MUST Microbiology Laboratories as backup) HIV – Uganda Virus Research Institute

Capacity for AMR Detection: Level No with capacity Comments National Reference 4 UNHLS – Bacterial, Fugal, Malaria UVRI – HIV, Influenza NTRL – Tuberculosis NADDEC – Animal Health National referral Hospital labs 2/2 Bacteriology GenXpert MTB Rif Universities 3/8 Research/Molecular capacity Alternate/Backup for Reference labs Regional Referral hospital labs 6/14 Limited Bacteriology Automated blood culture General hospital labs 10/125 All have GenXpert MTB Rif 10 have bacteriology capacity Specialty hospital labs 6 All refer their microbiology Private labs Potential site for AMR surveillance Animal labs 3/20 3 have Limited Bacteriology

Hub based specimen referral network – Shall form backbone for referral of microbiology specimens

Laboratory Information System being finalized shall ease information management :

Sites designated for antibiotic Resistance Surveillance: Facility level Number Potential sites No collecting data National Referral 2 1/2 1 Regional Referral 14 14/14 6 General hospital 125 8/125 Specialty hospital 0/6 Health Center IV 188 10/188 Total 335 40/373 Plan for surveillance in animals yet to be developed but assessment of lab capacity has been done

Laboratory & surveillance capacity development Mulago, RRHs & selected Gen. Hospitals Kampala Sites DEPARTMENT OF MED. MICROB UNHLS DMM/IDI LABS MULAGO MBALE FORT PORTAL? MBARARA MASAKA HOIMA SOROTI LIRA GULU MOROTO ARUA (BACTEC) MUBENDE (BACTEC) JINJA ( BACTEC) KABALE (BACTEC) TORORO APAC AFI & AMR SURVEILLANCE KISWA NAGURU BUTABIKA MARCH BAY NAKASERO MENGO MSAMBYA LUBAGA EBENEZER MBN KISENYI KIRUDDU KAWALA MARP MULAGO IDI CLINIC NON-AFI & AMR SURVEILLANCE SAMPLES TO UNHLS U/S SAMPLES T DATA TO UNHLS Red font: = active

Acute Febrile Illness (syndromic) Surveillance AMR data: Sentinel surveillance network for AFI in hospitalized children (8 sites). 7,360 children hospitalized during July 2016-Feb 2017 Blood cultures were performed on 1,351 (18.4%) 38 (2.8%) likely contaminants and 67 (5.0%) likely pathogens. Of the pathogens isolated: 43 (64.2%) were GNB of which 10 (14.9%) were MDR, including Klebsiella pneumoniae (3), Citrobacter freundii (2), Escherichia coli (2), Enterobacter species (2), and Klebsiella oxytoca (1). Of the 10 MDR GNB, 6 were isolated from patients in Jinja, 5 from patients in Arua, and 5 produced extended spectrum β-lactamase (ESBL)

Retrospective AMR data Arua RRH, Nov 16 Initiated AMR Data Sharing Workshop (March 2017)

ASANTE SANA