JMIR Publications

ABSTRACT

Background:

Antimicrobial resistance (AMR) is an existing and looming global challenge with serious health, social and economic consequences. Building social and ecological resilience to reduce AMR and mitigate its impact is critical.

Objective:

The objective is to describe the protocol for a study designed to compare and assess interventions that address AMR in humans, animals and/or the environment and engage diverse perspectives to determine what actions will help to build social and ecological capacity and readiness to tackle AMR now and in the future.

Methods:

We identify interventions that address AMR and its key pressure antimicrobial use in the scientific literature and through an online survey. Intervention impacts and the factors that challenge or contribute to the success of interventions will be determined, triangulated against expert opinion in participatory workshops, and complemented using quantitative time-series analyses. We will then identify indicators, using regression modelling, which can predict national AMU or AMR dynamics across animal and human health. Together, these analyses will help to quantify causal loop diagrams of AMR in the Europe and Southeast Asian food system context that are developed by diverse stakeholders in participatory workshops. Then, using these CLDs, the long-term impacts of selected interventions on AMR will be explored under alternate future scenarios via simulation modelling and participatory workshops. A publicly available and evolving learning platform housing information about interventions on AMR from a One Health perspective in a fully accessible online database will be developed, to help decision-makers to identify and adapt promising interventions for application in their jurisdictions.

Results:

This study is currently underway but not complete. Interventions from the case review and online survey have been identified, the expert-feedback and model-building workshops have been conducted, and collected data are currently being analysed. Time series analysis, regression modelling of national and regional indicators of AMR dynamics, and scenario modelling activities are anticipated to be completed by Spring 2021. Ethics approval has been obtained from the University of Waterloo’s Office of Research Ethics (ethics number: 40519 and 41781).

Conclusions:

This protocol provides an example of how to study complex problems like AMR, which require the integration of knowledge across sectors and disciplines, to develop and implement sustainable solutions. We anticipate our study will contribute to understanding about what actions to take and in what contexts to ensure long-term success in mitigating AMR and its impact, and provide useful tools (e.g., causal loop diagrams, simulation models, public database of compiled interventions) to guide management and policy decisions. Clinical Trial: N/A