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