July 01, 2024
Funding antibiotic research can help provide equitable access to essential drugs.
At a strategic roundtable discussion at the 77th World Health Assembly last month, OHT’s Dr. Ramanan Laxminarayan emphasized that while many people die from antimicrobial resistance (AMR), even more die from a lack of access to effective antibiotics. As evidenced in The Lancet’s series on AMR, more people die from bacterial infections than from tuberculosis, malaria, and HIV/AIDS combined. These stark findings underscore the urgent need for global funding for antibiotic research and development to improve access to essential medicines in high-burden settings. [The Independent]
Meta-regression analysis in assessment of the cost-effectiveness of health interventions
A meta-regression analysis of 25 interventions for HIV/AIDS, malaria, syphilis, and tuberculosis in 128 countries found that the incremental cost-effectiveness ratios (ICERs) for different interventions varied greatly between countries. In certain countries, such as Peru, most interventions (12 out of 14 analyzed) had an ICER below the country-specific threshold, making those interventions cost-effective. In contrast, only 6 of the 14 interventions analyzed were cost-effective in Sudan. Overall, antenatal syphilis screening had a low cost per disability-adjusted life-year gain and the lowest median ICER. The study also found that pre-exposure prophylaxis for men who have sex with men is associated with the highest median ICER. These findings demonstrate the utility of meta-regression analysis in synthesizing cost-effectiveness data for interventions across settings. [The Lancet Global Health]
Factors associated with poor practices of antibiotic dispensing without a prescription in Lahore
A cross-sectional study in Lahore, Pakistan, revealed that community pharmacists aged 31-40 were less likely (odds ratio = 0.57) to be associated with poor practices related to dispensing antibiotics without a prescription (DAwP) compared to those under 30. Pharmacists who were managers (OR = 4.22), had 3-5 years of experience (OR = 2.24), and dispensed less than 25 antibiotics per day (OR = 12.375) were more likely to be associated with poor practices related to DAwP. [PLOS One]
Decolonizing the global health mentorship agenda
Global health mentorship is crucial to capacity strengthening in low- and middle-income countries however, there is a need to consider power imbalances between Global North and Global South researchers. Currently, researchers from the Global South struggle to access mentorship opportunities, given the predominance of mentorship programs in high-income countries in the Global North. Linguistic and cultural barriers also impact Global South researchers’ ability to join sustainable partnerships. Furthermore, Global North mentors must acknowledge their privileges and address power imbalances to ensure ethical and bidirectional relationships with Global South mentees. [BMJ Global Health]
Antibiotic innovation is needed to mitigate the burden of high-priority ESKAPE pathogens.
The six ESKAPE pathogens are multi-drug resistant nosocomial pathogens that use various escape mechanisms to evade the current range of available antimicrobials. These mechanisms include changing outer membrane and cell surface characteristics, extruding antibiotics from inside a cell via efflux pumps, and genetic changes that prevent antibiotic binding. While several drug candidates are in the development pipeline (such as antimicrobial peptides and bacteriophages), no new antibiotic classes have been approved to treat ESKAPE pathogens since 2003. Funding the development of sustainable, accessible, and effective therapies is urgently needed to mitigate the burden of these highly resistant pathogens, many of which have developed multi-drug resistance. [PLOS Pathogens]
WHO report reveals limited market approval of novel antibacterials between 2017 and 2023.
The World Health Organization published a report on the status of antibacterial agents in the preclinical and clinical development pipeline worldwide. There are currently 97 agents and/or combinations in the antibacterial pipeline; however, only 21 comprise oral antibiotics, reflecting a decrease from 47 percent of the pipeline in 2017 to 37.5 percent in 2023. Between 2017 and 2023, only 16 new antibacterial agents have received regulatory approval. Recommendations from the report include increasing research support in LMICs, developing more oral formulations, expanding access to antibacterials, and providing incentives to small companies and biotechs. [WHO]
Barriers to seeking tuberculosis care in India
A systematic review found that male sex, older age (40+ years old), and lower socioeconomic status were risk factors for adverse outcomes across the tuberculosis (TB) care cascade in India, where two-thirds of symptomatic TB patients reported not seeking care in a 2019-2021 survey. People with low symptom severity or duration were less likely to have sought care and complete their diagnostic workup. Lack of TB knowledge contributed to both a lack of care-seeking and unfavorable treatment outcomes, highlighting the potential role of community awareness and education campaigns in closing this gap in India’s TB care cascade. [PLOS Medicine]
A call to evaluate disability-inclusive WASH interventions in LMICs
A review of the intersection of water, sanitation, and hygiene (WASH) and disability in LMICs revealed that few controlled studies assess the impact of disability-inclusive WASH interventions, limiting their prioritization for funding and political support. Research should be conducted to expand existing evidence of the needs and challenges faced by people with disabilities when accessing WASH information and services, particularly in the context of climate change, the health impacts of inadequate WASH, and inequitable WASH and education for children with disabilities. Disability-inclusive WASH programs should also be monitored and evaluated to reliably determine their impact on LMICs. [PLOS Water]
Anthropogenic pollution of aquatic environments may favor the spread of AMR.
Genomic analysis of treated wastewater and lake surface water samples revealed that anthropogenic pollution may shape aquatic microbiomes and favor the spread of antibiotic resistance genes (ARGs). The diversity of the microbial community, antimicrobial resistome, and high-risk ARGs were greater in the treated wastewater, which was more impacted by anthropogenic pollution than in the lake waters. Several ARGs were associated with plasmids, highlighting the role of anthropogenic pollution in the uptake of extracellular DNA and dissemination of ARGs in aquatic environments. [Journal of Hazardous Materials]
Risk factors for schistosomiasis and hookworm infection among children in Uganda
A cross-sectional study of school-aged children in Mayuge district, Uganda, found that longer water fetching time (adjusted odds ratio = 1.49) and working daily in the soil (aOR = 1.37) were significantly associated with hookworm infection. Living less than a one-hour walking distance to water bodies (aOR = 1.84) and not consistently washing hands before eating (aOR = 2.00) were associated with schistosomiasis. An annual mass drug administration (MDA) program against schistosomiasis and soil-transmitted helminths was implemented in Mayuge district in 2003, but these findings emphasize the importance of minimizing occupational and personal exposure to contaminated soil and water. [BMC Public Health]
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