在布基纳法索农村和刚果民主共和国的干预组与对照组中，评估行为干预组合对抗生素使用、医疗质量以及耐碳青霉烯类肠杆菌科细菌家庭传播的影响（CABU-EICO研究）。
Evaluating the effect of a behavioural intervention bundle on antibiotic use, quality of care, and household transmission of resistant Enterobacteriaceae in intervention versus control clusters in rural Burkina Faso and DR Congo (CABU-EICO).
出版信息
Trials. 2024 Jan 27;25(1):91. doi: 10.1186/s13063-023-07856-2.
BACKGROUND
Antimicrobial resistance (AMR) is a rising threat in low-resource settings, largely driven by transmission in the community, outside health facilities. Inappropriate antibiotic use is one of the main modifiable drivers of AMR. Its risk is especially high in poor resource settings, with limited diagnostic and surveillance capacities, and many informal medicine vendors determining community use. We hypothesise that to optimise community antibiotic use, especially Watch antibiotics (recommended only as first-choice for more severe clinical presentations or for causative pathogens likely to be resistant to Access antibiotics), both the supply side (medicine vendors) and the demand side (communities) should be pro-actively involved in any intervention.
METHODS
In two existing demographic health surveillance sites (HDSS) in Burkina Faso and in the Democratic Republic of Congo, behavioural intervention bundles were co-created in a participatory approach, aiming to rationalise (Watch) antibiotic use and improve hygiene and sanitation practices. Bundles consisted of interactive interventions, including theatre, posters, discussions, etc. To evaluate impact, 11 of 22 clusters (a HDSS community with at least one (in)formal medicine vendor) were randomly assigned to this intervention, which will run over a year. The effect of the intervention will be evaluated by comparing outcomes before and after in intervention and control villages from a) exit interviews of clients from vendors, b) mystery patients presenting to vendors with a set of predefined symptoms, c) household interviews to assess behavioural changes related to antibiotic use, health literacy and water-sanitation-hygiene indicators. Long-term impact on AMR will be estimated by modelling changes in resistant Enterobacteriaceae carriage from repeated household surveys before, during and after the intervention in both arms.
DISCUSSION
Most existing interventions aimed at improving antibiotic use focus on health care use, but in resource-limited settings, community use is highly prevalent. Previous studies targeting only providers failed to show an effect on antibiotic use. Evaluation will be done with before-after epidemiological measurements of actual prescriptions and use. If effective in reducing (Watch) antibiotic use, this would be an empowering methodology for communities, which has significant promise for long-term impact.
TRIAL REGISTRATION
ClinicalTrials.gov NCT05378880 . 13 May 2022.
背景
在资源匮乏地区，抗菌药物耐药性（AMR）构成的威胁日益增加，这在很大程度上是由社区（医疗机构之外）传播所致。抗生素使用不当是AMR的主要可改变驱动因素之一。在资源匮乏地区，其风险尤其高，诊断和监测能力有限，且有许多非正规药品供应商决定着社区用药情况。我们推测，为优化社区抗生素使用，尤其是“观察类”抗生素（仅推荐用于更严重临床表现或可能对“可获取类”抗生素耐药的致病病原体的首选治疗），供应方（药品供应商）和需求方（社区）都应积极参与任何干预措施。
方法
在布基纳法索和刚果民主共和国的两个人口健康监测点（HDSS），以参与式方法共同制定行为干预方案，旨在使（“观察类”）抗生素使用合理化，并改善卫生和清洁习惯。干预方案包括互动式干预措施，如戏剧表演、海报、讨论等。为评估干预效果，22个群组（一个HDSS社区，至少有一个正规或非正规药品供应商）中的11个被随机分配到该干预组，干预将持续一年。干预效果将通过比较干预组和对照组村庄在以下方面干预前后的结果来评估：a）对药品供应商客户的退出访谈；b）向药品供应商展示一组预定义症状的“神秘患者”；c）家庭访谈，以评估与抗生素使用、健康素养和水卫生与清洁指标相关的行为变化。通过对双臂干预前后多次家庭调查中耐药肠杆菌科细菌携带情况变化进行建模，来估计对AMR的长期影响。
讨论
大多数旨在改善抗生素使用的现有干预措施都集中在医疗保健用药方面，但在资源有限的环境中，社区用药非常普遍。以往仅针对医疗服务提供者的研究未能显示出对抗生素使用的影响。将通过对实际处方和用药情况进行前后对比的流行病学测量来进行评估。如果能有效减少（“观察类”）抗生素使用，这将是一种赋予社区权力的方法，有望产生重大的长期影响。
试验注册
ClinicalTrials.gov NCT05378880。2022年5月13日。
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