Characterizing social-ecological context and success factors of antimicrobial resistance interventions across the One Health spectrum: Analysis of 42 interventions targeting E. coli

Abstract

Background. Antimicrobial resistance (AMR) is among the most pressing One Health issues. While interventions and policies with various targets and goals have been implemented, evidence about factors underpinning success and failure of interventions in different sectors is lacking. The objective of this study is to identify characteristics of AMR interventions that increase their capacity to impact AMR. This study focuses on AMR interventions targeting E. coli.Methods. We used the AMR-Intervene framework to extract descriptions of the social and ecological systems of interventions to determine factors contributing to their success. Results. We identified 52 scientific publications referring to 42 unique E. coli AMR interventions. We mainly identified interventions implemented in high-income countries (36/42), at the national level (16/42), targeting primarily one sector of society (37/42) that was mainly the human sector (25/42). Interventions were primarily funded by governments (38/42). Most intervention targeted a low leverage point in the AMR system, (36/42), and aimed to change the epidemiology of AMR (14/42). Among all included publications, 55% (29/52) described at least one success factor or obstacle (29/52) and 19% (10/52) identified at least one success factor and one obstacle. Most reported success factors related to communication between the actors and stakeholders and the role of media, and stressed the importance of collaboration between disciplines and external partners. Described obstacles covered data quality, access to data and statistical analyses, and the validity of the results. Conclusions. Overall, we identified a lack of diversity regarding interventions. In addition, most published E. coli interventions were poorly described with limited evidence of the factors that contributed to the intervention success or failure. Design and reporting guidelines would help to improve reporting quality and provide a valuable tool for improving the science of AMR interventions.

Exploring the factors that contribute to the successful implementation of antimicrobial resistance interventions: a comparison of high-income and low-middle-income countries

“…A questionnaire was developed based on the AMR-Intervene framework to contextualize the social-ecological system (11,12), and it included specific questions about success factors and obstacles to intervention success. The final questionnaire was designed using Qualtrics Online Surveys and consisted of 50 questions.…”

“…Interventions were analyzed in their social context (e.g., income, location, and agents responsible) and ecological context (e.g., microorganisms and level of resistance). The context of the socialecological system was analyzed using the AMR-Intervene framework (11). For obstacles and intervention success factors, we performed an inductive thematic analysis to capture themes that contribute to positive outcomes from interventions tackling AMR, following the standard for reporting qualitative research (Supplementary Table S1) (18,19).…”

“…Implemented AMR interventions have targeted many settings and scales with varying impacts due to the influence of the context in which they take place (11,12). While interventions can enhance resilience toward AMR, information about AMR interventions and their social-ecological context remains limited (12).…”

“…While interventions can enhance resilience toward AMR, information about AMR interventions and their social-ecological context remains limited (12). Bridging this gap may be key to building and strengthening resilience in human and animal health systems (6,11,13). There is a need to strengthen the design and implementation of AMR interventions with translatable information about their effectiveness.…”

“…It is important to understand what key factors make interventions successful or hinder their success within and across a range of contexts that are still poorly known (14). Comprehensive frameworks, such as AMR-Intervene, aim to detail relevant information about both the interventions and the socialecological context (11), but available information may be insufficient if there is incompleteness in intervention design or implementation, incompleteness or lack of reporting, or difficult and time-delayed assessments (12,15).…”