1. Uganda Antimicrobial Resistance Surveillance Plan 2017 - 2022
Kajumbula Henry
Chair AMR Surveillance Taskforce

2. AMR Surveillance Central to Plans to Combat AMR
Strengthen the knowledge and evidence base through surveillance and research
Awareness and understanding of AMR –
Effective communication, education and training
Develop the economic case for sustainable investment:
New medicines, diagnostic tools, vaccines and other interventions
Optimize the use of antimicrobial medicines in human and animal health.
Reduce incidence of infection through effective sanitation, hygiene and infection prevention measures
Located at the Equator and in the tropics

3. Roles of AMR Surveillance
Lots of tropical rain forests and wildlife impact on overall health

4. World AMR Surveillance situation :
There is a general lack of surveillance data (particularly for antibiotic resistance) in many parts of the world

5. Uganda National AMR Surveillance Plan
Uganda has developed a plan for AMR Surveillance 2017/2021

6. World Health Organization
27 June, 2018
WHO launched the Global antimicrobial resistance surveillance system (GLASS)
Oct 2015 WHO launched the Global AMR Surveillance System (GLASS)

7. Development of AMR Surveillance plan for Uganda
October 2015 DGHS appointed a taskforce to develop a plan for AMR surveillance
The taskforce developed a draft plan based on GLASS and submitted it to the DGHS in September 2016

8. AMR Surveillance Taskforce
Dr. Kajumbula Henry
Mr. Lalli William
Prof Denis Byarugaba
Mr. Obua Thomas Ocwa
Mr Gaspard Guma
Mr. Wejuli Alfred Mayende -
Mr. AISU Steven
Dr. Mwangi Christina
Dr. Florence Tugumisirize
Mr Stefano Tugume
Mr Richard Walwema
Ms Hellen Ndagije
Dr. Robert Downing
Mr. Richard Walwema
Mr Sam Lubwama
Dr. Muhamed Larmorde
Prof. Herbert Nsanze
Dr. Franklin Kizito
Mr. LL Kerchan
Dr. Christine Kihembo
Mr. Wewendru Izale

9. Objectives of the Uganda AMR Surveillance Plan
To estimate the extent and burden of AMR in human/zoonotic pathogens in Uganda
To analyze and report Uganda data on AMR on a regular basis,
To detect emerging AMR in Uganda,
To inform the implementation of targeted prevention and control measures,
To assess the impact of interventions.

10. Plan outlines 7 strategic approaches
National Leadership & Coordination of AMR surveillance
Selecting surveillance sites that shall provide reliable, representative data
Strengthening laboratory capacity for AMR surveillance
Strengthening data collection and management

11. Plan outlines 7 strategic approaches
Strengthening the human resource capacity for AMR surveillance
Resource Mobilization and Financing for AMR
Monitoring and Evaluation (M&E) Plan and a reporting and data-sharing system for AMR surveillance

12. National Leadership & Coordination of AMR surveillance
The Surveillance Sub-committee of the Uganda National Antimicrobial Resistance Committee
Coordination centers for AMR surveillance based on the pathogens
Bacterial/ fungal – UNHLS
HIV – UVRI
Malaria – UMCP
Tuberculosis – NTLP

13. National Leadership & Coordination of AMR surveillance
National Reference laboratories:
Tuberculosis – NTRL
Malaria – UNHLS (Mak CHS Malaria Research Laboratory as a backup)
Bacteriology & Mycology – UNHLS (Mak CHS & MUST Microbiology Laboratories as backup)
HIV – Uganda Virus Research Institute

14. Capacity for AMR Detection:
Level
No with capacity
Comments
National Reference 4
UNHLS – Bacterial, Fugal, Malaria
UVRI – HIV, Influenza
NTRL – Tuberculosis
NADDEC – Animal Health
National referral Hospital labs
2/2
Bacteriology
GenXpert MTB Rif
Universities
3/8
Research/Molecular capacity
Alternate/Backup for Reference labs
Regional Referral hospital labs
6/14
Limited Bacteriology
Automated blood culture
General hospital labs
10/125
All have GenXpert MTB Rif
10 have bacteriology capacity
Specialty hospital labs 6
All refer their microbiology
Private labs
Potential site for AMR surveillance
Animal labs
3/20
3 have Limited Bacteriology

15. Hub based specimen referral network – Shall form backbone for referral of microbiology specimens

16. Laboratory Information System being finalized shall ease information management :

17. Sites designated for antibiotic Resistance Surveillance:
Facility level
Number
Potential sites
No collecting data
National Referral 2
1/2 1
Regional Referral 14
14/14 6
General hospital
125
8/125
Specialty hospital
0/6
Health Center IV
188
10/188
Total
335
40/373
Plan for surveillance in animals yet to be developed but assessment of lab capacity has been done

18. Laboratory & surveillance capacity development
Mulago, RRHs & selected Gen. Hospitals
Kampala Sites
DEPARTMENT OF MED. MICROB
UNHLS
DMM/IDI LABS
MULAGO
MBALE
FORT PORTAL?
MBARARA
MASAKA
HOIMA
SOROTI
LIRA
GULU
MOROTO
ARUA (BACTEC)
MUBENDE (BACTEC)
JINJA ( BACTEC)
KABALE (BACTEC)
TORORO
APAC
AFI & AMR SURVEILLANCE
KISWA
NAGURU
BUTABIKA
MARCH BAY
NAKASERO
MENGO
MSAMBYA
LUBAGA
EBENEZER
MBN
KISENYI
KIRUDDU
KAWALA
MARP MULAGO
IDI CLINIC
NON-AFI & AMR SURVEILLANCE
SAMPLES TO UNHLS
U/S SAMPLES T
DATA TO UNHLS
Red font: = active

19. Acute Febrile Illness (syndromic) Surveillance
AMR data: Sentinel surveillance network for AFI in hospitalized children (8 sites).
7,360 children hospitalized during July 2016-Feb 2017
Blood cultures were performed on 1,351 (18.4%)
38 (2.8%) likely contaminants and 67 (5.0%) likely pathogens.
Of the pathogens isolated:
43 (64.2%) were GNB of which 10 (14.9%) were MDR, including Klebsiella pneumoniae (3), Citrobacter freundii (2), Escherichia coli (2), Enterobacter species (2), and Klebsiella oxytoca (1).
Of the 10 MDR GNB, 6 were isolated from patients in Jinja, 5 from patients in Arua, and 5 produced extended spectrum β-lactamase (ESBL)

20. Retrospective AMR data
Arua RRH, Nov 16
Initiated AMR Data Sharing Workshop (March 2017)

21. ASANTE SANA