“AMR Dialogues”: a public engagement initiative to shape policies and solutions on antimicrobial resistance (AMR) in Thailand

Abstract

Background: The use of antimicrobials in Thailand has been reported as one of the highest in the world in both the human and animal sectors. The objectives of this project are: (1) to improve understanding of the issue of antimicrobial resistance (AMR) among adult Thai communities and (2) to drive change through the national AMR policy to include context-specific and locally-driven solutions. Methods: The project contains two components conducted in parallel: the “AMR Dialogues” public engagement project and the embedded evaluation of the project. We will bring together AMR stakeholders and members of the public through a series of conversation events to co-create an AMR stakeholder map, engagement strategy, and context-specific solutions to reduce the burden of AMR. There will be a combination of regional in-person events (‘regional conversations’) and national online events (‘national conversations’) with members of the public and AMR stakeholders. The conversations will follow this sequence: introduce and explore issues related to AMR, brainstorm solutions and finally propose promising/feasible solutions to take forward. Evaluation of the project will be conducted to assess if the AMR Dialogues objectives have been achieved using feedback forms and qualitative methods. Ethics: Approval of the evaluation component of the project has been obtained from the ethics committee of the Thailand Institute for the Development of Human Subject Protection (IHRP2021059) and the Oxford University Tropical Research Ethics Committee (OxTREC 529-21). Dissemination: The results of these conversation events will inform the next Thailand National Strategic Plan on AMR. The learning and outcomes will be disseminated to AMR policy makers, academic audiences, and participants of all the conversation events. Thaiclinicaltrials.org registration: TCTR20210528003 (28/05/2021)

Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries

“…Context-specific solutions require dialogue and in-depth engagement to include voices from the most vulnerable communities. 17 Interventions to curb the spread of AMR and AMR NAPs should consider the ethical tensions outlined in our analysis. If well-meaning interventions fail to take these tensions into consideration, the most vulnerable communities could end up shouldering the largest burdens.…”

“…To do so, we draw on some of our own experiences living in LMICs, interacting with communities (eg, via community advisory boards, community clinics, clinical trials and primary healthcare services in remote communities) 14 and conducting research on the issues related to AMR in LMICs, particularly South and Southeast Asia and Sub-Saharan Africa. [14][15][16][17][18][19][20] The ethical tensions laid out in this article are thereby juxtaposed with day-to-day lived experiences of stakeholders in AMR interventions in LMICs, particularly the practicalities of health services and patients' interactions with both formal and informal healthcare providers. Aligning with our experiences, we focus more on human health and less on animal and environmental health.…”

Embedding community and public voices in co-created solutions to mitigate antimicrobial resistance (AMR) in Thailand using the ‘Responsive Dialogues’ public engagement framework

“…The evaluation process was integrated into the project from its outset to have a continuous feedback loop 21 . Evaluation included feedback forms immediately after the Conversations and focus group discussions (FGDs) with selected participants.…”

“…The main objectives of our project were 1) to improve our understanding of the issue of antimicrobial use and AMR among adult Thai communities, and 2) to co-create locally relevant solutions to AMR, thereby improving policies for reducing the burden of AMR in Thailand 21 . For practical reasons, we narrowed our scope to interventions and solutions that are actionable by those who participate in the project, in particular those related to engagement and awareness around AMR.…”

“…thereby improving policies for reducing the burden of AMR in Thailand 21 . For practical reasons, we narrowed our scope to interventions and solutions that are actionable by those who participate in the project, in particular those related to engagement and awareness around AMR.…”