Partnerships to Contain AMR in South America: Local Strategies to Contain AMR in Peru

Transcription

1 Partnerships to Contain AMR in South America: Local Strategies to Contain AMR in Peru South American Infectious Disease Initiative Global Health Council s s 34th Annual International Conference on Global Health June 2007 Session E3 - Containing Antimicrobial Resistance in South America: An Integrated Approach Time: 2:45-4:45pm 4:45pm Location: Congressional Room A

2 Local Strategies to Contain AMR in Peru Marisabel Sánchez,, MPH Links Media

3 New and Old Partners Working Together Ministry of Health: (Various departments at central and regional levels) Projects/Programs (VIGIA) Universities (U. Mayor de San Marcos, U. Peruana Cayetano Heredia) Civil Society (Servicio de Medicinas PRO-VIDA, Acción Internacional para la Salud) Local Governments (Municipality of Lima, Municipalities of Callao and BEPECA) Private Sector (Pharmaceutical laboratories and pharmacies--chain and privately owned)

4 Quality of ATM Drugs Assessment Audited lab management system against ISO 17025:2005 standard

5 Assessment Nosocomial Infection Control Assessment of compliance with nosocomial infection control norms in major hospitals

6 Assessment Accessibility and Use of ATM in Health Centers Availability of commonly use ATM at public and private health facilities Price fluctuation of ATM in public and private pharmacies

7 Prescribing Practices Assessment Survey of physicians (SERUMS, no SERUMS) and medical residents Review of prescriptions Interviews of physicians assessing KAP and perceptions

8 Dispensing Practices Assessment Simulated purchase of ATM without prescription Substitution of generics by dispensers Interviews of pharmacists and sales staff assessing KAP and perceptions

9 Consumer Practices Assessment Consumer qualitative study assessing KAP and perceptions Consumer surveys assessing KAP and perceptions related to ATM use

10 Intervention Area Peru

11 Intervention Development of strategies and a work plan Implementation of pilot to address multiple determining factors of AMR Objective to reduce inappropriate use of ATM in patients under five years of age with respiratory infections

12 Intervention Objective 1: At the end of one year use of ATM for respiratory infections in patients under 5 years of age is decreased. Expected Results 1. Prescribers use the STGs to treat respiratory infections. 2. Prescription and dispensation of ATM complies with norms. 3. Drug Information Center is operational. 4. Health staff complies with nosocomial infections control norms.

13 Intervention Objective 2: Prescribers use ATM resistance surveillance data primarily to treat respiratory infections in the population of under 5 years of age. Expected Results 1. A quality ATM Resistance Surveillance Network is operational. 2. Prescribers use ATM resistance surveillance results data.

14 Intervention Objective 3: Population has access to quality and relevant information about ATM use. Expected Results 1. Increased percentage of public and private pharmacies inspected. 2. ATM are stored according to GSP and have timely distribution. 3. Increased percentage of public pharmacies offer information during the dispensation of ATM.

15 Intervention Objective 4: At the end of one year, access to information about the risks of inappropriate use of ATM for mothers of children under five years of age is improved. Expected Results 1. Mothers have adequate information about ATM. 2. Public policy makers and leaders adopt the initiative in the region. 3. Grade schools know about ATM use. 4. Community workers promote appropriate use of ATM. 5. Pharmacies become promoters of appropriate use of ATM.

16 Intervention Objective 1 Development of a Drug Information Center in Callao Office space re-modeled and reference materials purchased. Computer and equipment to be purchased. Course on critical review of literature is planned for October Implementation work plan to be finalized.

17 Objective 1 Intervention Implementation of STGs for Respiratory Infections in Children Under Five An initial version of the STGs was drafted and validated. APUA/Peru and national partners will finalize, print and distribute guides. The dissemination and implementation plan in progress.

18 Intervention Objective 1 Development of Hospital Infections Control Self-diagnostic Tool Hospitals were trained in the use of the tool. Training follow-up will be provided. A meeting to review results and plan follow-up interventions is scheduled.

19 Intervention AMR Surveillance Data Translation Objective 2 Strengthening the surveillance network in Callao. Model for reporting on drug resistance data for clinicians and policymakers was developed by APUA.

20 Intervention Quality of ATM Drugs Objective 3 Registration Trained DIGEMID staff on use of WHO s Registration Software (SIAMED) Supported optimization of registration software QC lab (CNCC) Trained ( 26 staff) in GLP, Dissolution, HPLC, UV, and use of USP/NF Created action plan to obtain ISO 17025:2005 accreditation Sampling and Testing (Public and Private Sectors) 1st round: 76 samples (63 antibiotic, 13 anti-tb) 2 nd round in progress (medications with nonconformance from 1st round)

21 Medicines Storage Intervention Objective 3 DIGEMID and DIREMID developed a plan to improve storage in Callao and a plan for accreditation of the regional warehouse GSP. Pharmacy personnel trained in GSP. SOPs developed and under revision. Training of pharmacy personnel on new SOPs is scheduled. Re-modeling of regional warehouse in progress.

22 Intervention Objective 3 Development of TB Interventions in the Private Sector Assessment of first-line anti-tb medicines in private pharmacies in Callao was conducted. Workshop to define intervention is planned for June 2007.

23 Intervention Development of SOPs for Pharmaceutical Management of MDR-TB Medicines SOPs to be developed. Objective 3

24 Objective 4 Intervention Development and Implementation of Social Marketing Campaign Strategic and work plans were developed and communicated to key stakeholders. Materials under development to be validated with the audience. Dissemination plan completed. Campaign launch and activities planned for July 2007.

25 Objective 4 Intervention Community Mobilization Strategic and work plans were developed and communicated to key stakeholders. Meetings with community workers and health promoter coordinators completed. TOT curriculum drafted, under validation, and final revision. Trainings for community workers and health promoters scheduled for July 2007.

26 Objective 4 Advocacy Intervention Meetings with authorities conducted and official letters of commitment signed. Meetings with private sector, and signatures of official letters of commitment in progress. News media presentations and interviews in progress. Policy recommendation document drafted, to be reviewed and finalized by July 2007.

27 Objective 4 Intervention Integration into School-based Program Meetings with school administrators, teachers and parents leadership completed. TOT curriculum drafted, and under validation and final revision. Development of educational materials in progress. Trainings and educational sessions scheduled.

28 Intervention Social Responsibility Campaign Objective 4 Quality pharmacies recognition project proposal for private pharmacies presented to stakeholders. Signatures of letters of commitment in progress. Promotional materials in development. Official launch and media promotion scheduled.

29 Evaluation Monitoring and evaluation plan developed by objective #4 workgroup. Process and output indicators identified for objectives 1-3. Overall SAIDI initiative plan in progress.

30 Preliminary Results Greater capacity to assess activities and plan strategically. Strengthened capacity to collaborate with private sector and civil society. Paradigm shift in the overall approach to working across sectors. Innovation in the approach especially in communication and advocacy.

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33 For more information: www1.msh.org/projects/rpmplus/wherewework/latinamericacaribbean/saidi.cfm

34 Acronyms & Abbreviations AMR Antimicrobial Resistance (Resistencia Antimicrobiana) APUA Alliance for Prudent Use of Antibiotics DGE Dirección General de Epidemiología DGPS Dirección General de Promoción de la Salud DGSP Dirección General de Salud de las Personas DIGEMID Dirección General de Medicamentos, Insumos y Drogas DIGESA Dirección General de Salud Ambiental DIREMID Dirección Regional de Medicamentos, Insumos y Drogas DISA Callao Dirección de Salud Callao EESS Establecimientos de Salud GSP Good Storage Practices (Buenas Prácticas de Almacenamiento) HPLC: High Performance Liquid Chromatography INS Instituto Nacional de Salud ISO International Organization for Standardization MDR-TB Multiple Drug Resistant Tuberculosis (Tuberculosis Multidrogo Resistente) MOH Ministry of Health (Ministerio de Salud) OGCI Oficina General de Comunicaciones BEPECA Red Bella Vista, La Perla y Carmen Legua SAIDI South American Infectious Disease Initiative SERUMS Servicio Rural Urbano Marginal SOPs Standard Operating Procedures (Procedimientos Operativos Estándar) STGs Standard Treatment Guidelines (Guías de Tratamiento Estándar) TB Tuberculosis TOT Train-the-Trainer (Entrenado entrenadores) USP United States Pharmacopeia UV Ultraviolet Spectrophotometry