Workstream Title
Development and validation of novel metrics for global surveillance of primary healthcare antibiotic use (AWaRe1 – WS1 Surveillance)
Study Design
Prospective observational study, multiple survey types
Participant Population
Exit interviews (EI): customers presenting at randomly selected primary healthcare facilities that have received an antibiotic prescription for an acute respiratory infection (ARI) affecting themselves or their child.
Observer-led point prevalence survey (oPPS) and prescriber-led PPS (pPPS): customers presenting at the same primary healthcare facilities that consult for any of the following symptoms/diagnoses affecting themselves or their child:
- Acute cough (<14 days)
- Sore throat/pharyngitis/tonsillitis
- Runny nose/nasal congestion/coryza
- Sinusitis/facial pain or pressure
- Middle ear pain/otitis media
- Acute diarrhoea/gastroenteritis
Planned Sample Size
- EI: 2,400 patients
- oPPS: 7,200 patients
- pPPS: 7,200 patients
- Qualitative interviews with patients: 40
- Qualitative interviews with healthcare professionals: 40
Follow up duration
Patients will not be followed up
Planned Study Period
April 2025 – September 2028
Research Aims
The overall aim is to evaluate a range of novel survey methods and define the optimal flexible and generalisable survey method, including an interactive tool that could potentially be integrated into existing WHO surveys, (e.g., the Demographic and Health Surveys, Service Provision Assessment, healthcare facility exit survey), to estimate total community use of antibiotics in low- and middle-income country (LMIC) primary healthcare facilities, which could be used for both surveillance and evaluation of interventions aimed at optimising antibiotic use.
The main outcome measures of this workstream are population-level antibiotic exposure and antibiotic use within the studied communities. Antibiotic exposure is expressed in two ways:
Primary outcomes:
i) the total antibiotic prescribing/dispensing rate for any reason; and
ii) the antibiotic prescribing/dispensing rate for ARIs and gastrointestinal infections (GIs).
Secondary outcomes:
- To determine the accuracy, agreement between, and cost of different survey modes – observer recorded, prescriber recorded, or patient reported (through exit interviews at the clinic or participatory surveillance from the public), and where available, routinely collected health records – for estimating total antibiotic prescribing/dispensing in the community.
- To establish the presentation rates of different ARIs and gastrointestinal infections, i.e., the most common indications for antibiotic prescribing, in primary healthcare facilities in LMICs
- To estimate antibiotic prescribing proportions for different ARIs and gastrointestinal infections in primary healthcare facilities in LMICs.
- To evaluate the potential generalisability of the future AWaRe1 trial findings by comparing consultation rates for ARI and corresponding antibiotic prescribing proportions in trial sites (from AWaRe1 – WS3 Trial) with healthcare facilities in AWaRe1 – WS1 Surveillance.
- To assess the availability and cost of antibiotics in different areas, potentially facilitating external reference pricing.
- To understand patients’ and healthcare professionals’ experiences of and preferences about antibiotic treatment of ARIs, and the contextual determinants of antibiotic prescribing.
WS1 Team Leads
Dr Nga Thi Thuy Do
(Co-Chief Investigator WS1)
Centre for Tropical Medicine
Oxford University Clinical Research Unit (OUCRU)
🇻🇳 Vietnam
Dr Koen Pouwels
(Co-Chief Investigator WS1)
Nuffield Department of Population Health (NPH)
University of Oxford
🇬🇧 United Kingdom
Aislinn Cook
Centre for Neonatal and Paediatric Infection (CNPI)
City St George’s, University of London
🇬🇧 United Kingdom
