FIND Study: DIAGNOSTICS USE ACCELERATOR STUDY.
Study period:Ongoing.
Febrile illnesses are often under-diagnosed and over-/mistreated. Antibiotic self-treatment and over-prescription drive antimicrobial resistance (AMR), with both immediate and long-term consequences on both individuals’ health and health systems. At the same time, patients who really do need antibiotics may not get them, which can lead to avoidable morbidity and mortality. Causes of fever vary geographically and seasonally, but there are few diagnostics to inform clinical decision making. WHO guidelines exist for children only (integrated management of childhood illnesses; IMCI), and there is no validated all-age syndromic approach.
Many febrile illnesses, especially in children, present with highly non-specific and overlapping signs and symptoms that are difficult to distinguish clinically. In Africa alone, over 600 million childhood fevers occur every year. However, when faced with a patient presenting with fever, healthcare providers, especially in low-resource settings, are left with nothing but their clinical judgment to decide whether antibiotics are needed – and often fall into the habit of prescribing one ‘just in case’. The AMR Dx Use Accelerator addresses the critical steps in the decision-making process by studying the effects of providing a set of available, point-of-care diagnostic tests and algorithms to use these tests to reach a case management decision. It also studies the underpinning behaviours that make health providers prescribe and users demand antibiotics, and favour or prevent adherence to prescription.
The FIND AMR Diagnostic (Dx) Use Accelerator is a platform to evaluate a package of interventions and provide evidence to inform policy change that can positively impact management of febrile illness, reduce drug pressure selecting for AMR, and contribute to universal health coverage (UHC). It will ultimately help prepare for the introduction of new diagnostics and provide a safe environment for new antibiotics to enjoy a longer useful therapeutic lifespan.
Objectives:
- To understand the key drivers and barriers to delivering communication about adherence to prescriptions to patients/caregivers by health workers;
- To understand the key drivers and barriers to adherence to prescribing instructions by patients/caregivers;
- To assess the impact of a package of interventions on clinical outcomes and antibiotic prescriptions compared with standard-of-care practices, in patients presenting with acute febrile illnesses (defined as fever with no focus or respiratory tract infection lasting for no more than 7 days) at outpatient clinics in Uganda.
The study sites are: Aduku, Kihihi, and Nagongera Health centre IVs located in Kwania, Kanungu, and Tororo districts respectively.
Collaborators:
Principal Investigators: Dr James Kapisi and Dr Heidi Hopkins
Project Coordinator: Dr Asadu Sserwanga
Funded by: Foundation for Innovative new Diagnostics (FIND) in Geneva, Switzerland.
