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Table 1 Variables to explore for sustainable future access and appropriate use interventions

From: Towards the just and sustainable use of antibiotics

Theme Rationale Variables to explore for intervention
Access strategies How should antibiotics be made available to all members of a community? Roll out options, referral patterns, training community health workers to prescribe appropriately, exclusive vendor availability
Antibiotic quality Measures to ensure antibiotic quality Roles of different actors, effective technologies for low resource settings, drivers of quality
Decision making and help seeking (unlocking capabilities) Strategies to enable people to treat infections when necessary while reducing risks of resistance Suppliers of advice and drugs, role of financial incentives, assessment of risk and need, professional and social norms, understandings of disease and antibiotics, ideas of entitlement, design of packaging
Therapeutic and dosing strategies Optimising drug use strategies based on the scientific, economic, social and epidemiological context Explore antibiotic combinations, co-administration, co-formulation, cycling, best practice for frequency and adherence to dosing strategies
Use of diagnostics How can diagnostics improve diagnosis and treatment and be relevant in low resource settings Dual diagnosis of infection and resistance in low resource settings, meeting the needs of populations, integration with surveillance, effects on access to care, treatment-seeking behaviour or supply stock-outs, prescription/antibiotic use
Exploring integration of new strategies Transmission of health behaviour messaging integration of appropriate use measures into everyday practices. Explore innovative ways of tracking, diagnosis, treatment, reporting, messaging and the surveillance of resistance and antibiotic use How can mobile health technology be incorporated to improve diagnosis, treatment and surveillance; can social media be used to encourage appropriate use of new/existing therapies; role of pharmaceutical companies and appropriate use
The role of markets and market actors Effective strategies for involving players at every level in the market (local, national, regional, international) and aligning incentives Roles/responsibilities for information transmission, guideline adherence, positive incentive creation, measures to improve access and reduce resistance
Consensus and coalition building Building (and negotiating) shared visions of just and sustainable use Mapping competing understandings and interests of relevant organisations and associations; Building of coalitions for change
Governance Effective mechanisms at the community and regional level for ensuring sustainable access and use of antibiotics Agreed roles and responsibilities, effective funding streams, harmonisation where possible
Evaluation of systems Observe impact of interventions Other health consequences, clinical outcomes of AMR, resistance in the environment, health seeking behaviour and wider social consequences (economic, networks)
Identify unintended consequences