Management of the Consortium
As the lead partner, the Liverpool School of Tropical Medicine (LSTM) will oversee this multi-partner project to ensure good progress and communication, using agreed management arrangements.
Good management in a multi-partner research project of this scale and complexity is an essential requirement.
The lead partner (LSTM) will monitor the progress of all workstreams to ensure appropriate progress and communication. It will encourage partners to identify, acknowledge and address any problems as soon as they arise and will negotiate and coordinate changes to workplans and task allocation throughout the lifetime of the project.
Key features of the management arrangements are shown in the organogram below.
Economics of antibiotic resistance
The economic consequences of Antibiotic resistance in Africa are not known. DRUM will estimate the economic costs of antibiotic resistance and explore the cost-effectiveness of potential interventions.
Antibiotic resistance likely to lead to increased healthcare costs
Antibiotic resistance impacts on people’s health, but little is known about how this translates into the cost of providing healthcare in Africa.
Resistance to commonly used antibiotics agents in the region is likely to result in more costly or intensive use of healthcare services by those affected. Linking the economic and health consequences of antibiotic resistance is essential for policymakers to better understand the value of investing in strategies to mitigate further resistance developing.
DRUM will estimate economic costs of antibiotic resistance
We will estimate the additional costs of providing in-patient medical care as a result of antibiotic resistance. We will then extrapolate these costs to the national level to estimate the current and future economic burden of antibiotic resistance. We will estimate the economic costs of rising resistance and potential investments that could be made by implementing effective strategies.
Cost-effectiveness of interventions including in DRUM modelling
The economic findings will also be utilised in the wider DRUM work adding an economic component to the modelling work being undertaken. Costs estimated in this work strand will be utilised in the modelling work to explore the cost-effectiveness of potential interventions.
We will undertake longitudinal microbiological surveillance of humans, animals, and their environment, at randomly selected households. This will help us to determine risk factors for community prevalence of, and the evolutionary dynamics of antibiotic resistance acquisition in E. coli (ESBL-E) and K. pneumoniae (ESBL-K).
Research Goal: understanding the dynamics of antibiotic resistance acquisition
To model the drivers of antibiotic resistance-transmission and understand the dynamics of ESBL-E and ESBL-K and their ecological niche, we will undertake detailed, longitudinal microbiological surveillance of humans, animals and the environment.
Scientific methodology: household sampling and whole-genome sequencing
Household stool and environmental sampling
We will collect geolocated samples from humans, animals and the environment from up to 100 randomly selected households in each of our study sites to determine community prevalence of ESBL-E and ESBL-K, and risk factors for acquisition.
Households will be intensively microbiologically characterised, sampling:
- stool from all humans
- stool from all companion domestic animals
- stool from a sample of wild animals
- representative samples from the broader household and community environment
These methods have been developed in collaboration with the Food, Water and Environment laboratories, Public Health England, Colindale.
We will also test environmental samples for antibiotic and heavy metal residue in collaboration with the Centre for Ecology and Hydrology.
Through whole-genome sequencing (WGS) of the household samples at the Wellcome Sanger Institute we will characterise:
- bacterial isolates
- mobile genetic elements
- genes, and
- intrinsic mutations associated with antibiotic resistant bacteria