2024-25 Project (Sadiq & Moore & Holt & Lindsay)

Community antimicrobial resistance in patients with uncomplicated urinary tract infections and antimicrobial use in the community in Kampala, Uganda

SUPERVISORY TEAM

Supervisor

Professor Tariq Sadiq at SGUL
Email: ssadiq@sgul.ac.uk

Co-Supervisor

Dr Catrin Moore at SGUL
Email: camoore@sgul.ac.uk

Co-Supervisor

Professor Kathryn Holt at LSHTM
Email: kat.holt@lshtm.ac.uk

Co-Supervisor

Professor Jodi Lindsay at SGUL
Email: jlindsay@sgul.ac.uk

PROJECT SUMMARY

Project Summary

The burden of antimicrobial resistance is extremely high in sub-Saharan Africa, with treatment becoming increasingly complex. High background carriage rates of resistant bacteria in sub-Saharan Africa may be increasing the prevalence of disease with resistant bacteria.   

There are a decreasing number of effective antibiotics to treat infectious diseases due to resistance and the lack of access to antibiotics in many countries. This PhD project will describe the aetiology of urinary tract infections in communities in Kampala, Uganda. This includes the prevalence of bacteria being carried with antibiotic resistance genes in the community, together with the treatment for these infections. The work will examine the knowledge of local actors about AMR, develop a strategy to improve treatment, and reach out to local stakeholders to ultimately change local policy in view of the project results.   

This project offers the successful candidate the opportunity to join three successful departments:
1) the AMR team in the Centre for Neonatal and Paediatric Infection, St George’s, University of London
2) the Department of Disease Control at the London School for Hygiene and Tropical Medicine and
3) the Institute of Infection and Immunity, St George’s. It is linked to a Wellcome Trust funded project to examine uncomplicated urinary tract infections in two communities in Kampala, Uganda.

Project Key Words

Antimicrobial resistance, antimicrobial use, genomics, microbiology, policy.

MRC LID Themes

  • Global Health = Yes
  • Health Data Science = Yes
  • Infectious Disease = Yes
  • Translational and Implementation Research = Yes

Skills

MRC Core Skills

  • Quantitative skills = Yes
  • Interdisciplinary skills = Yes
  • Whole organism physiology = No

Skills we expect a student to develop/acquire whilst pursuing this project

Analytical skills; quantitative and qualitative encompassing epidemiological design, statistical analysis and interpretation based on local context

Routes

Which route/s is this project available for?

  • 1+4 = Yes
  • +4 = Yes

Possible Master’s programme options identified by supervisory team for 1+4 applicants:

  • LSHTM – MSc Epidemiology
  • LSHTM – MSc Health Data Science
  • LSHTM – MSc Medical Microbiology
  • LSHTM – MSc Public Health

Full-time/Part-time Study

Is this project available for full-time study? Yes
Is this project available for part-time study? Yes

Eligibility/Requirements

Particular prior educational requirements for a student undertaking this project

  • SGUL’s standard institutional eligibility criteria for doctoral study.
  • Epidemiology background and a knowledge of AMR

Other useful information

  • Potential CASE conversion? = No
  • Change of primary supervisor following transfer: Professor Sadiq will be the Primary Supervisor for this project until upgrading. After that the team envisages that Dr Moore will take over as Primary Supervisor (pending RD Committee approval).

PROJECT IN MORE DETAIL

Scientific description of this research project

The PhD project will be nested in a Wellcome Trust funded project examining the organisms causing urinary tract infections, resistance profiles, antibiotic usage and drivers of antibiotic resistance in two (socioeconomically differing neighbourhoods) communities in Kampala, Uganda. The problem of AMR is believed to stem from the community but most data available is hospital-based. The student will join during the data collection phase of the project.   

The objectives of this project will be to: 
Determine the extent of the public health issue due to multidrug resistant organisms (MDROs) causing uncomplicated urinary tract infections (UTIs) in Uganda together with local methods to mitigate the problem.   

Techniques to be used: 
– a systematic review of uncomplicated UTIs caused by MDROs in Africa 
– collect primary data on aetiology of UTIs (bacterial causes and resistance), antibiotic dispensing and usage, embedded in the research team (first six months of the project) 
– extract data from the main project, analyse data and describe the resistance patterns of bacteria causing UTIs and the use of antibiotics – collected in the main project 
– work with local stakeholders (such as ministers of Health, policy makers) to determine how the evidence can influence local and national policy on AMR   

Availability of databases and specialist materials:
Data collection for the overarching study will begin on the 1st of July 2023 in pharmacies and outpatient clinics in Kampala, Uganda. The data collected will include samples (urines, perianal swabs) – for phenotypic and genotypic analysis, demographic and patient details, antimicrobial use (from patients and pharmacists), outcomes of treatment. Data collection completes on the 30th June 2024. This data will be available for analysis by the student.   

Potential risks to the project include: 
– problems with data availability given this is nested in a prospective collection of data. The mitigation includes the analysis of retrospective data already collected by Makerere University and shared with the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS). 
– Difficulty meeting with the supervisors given two are based in the UK and the project will be in Uganda. The mitigation includes regular online meetings setup from the outset and annual face to face meetings, based around international conferences. 
– Difficulty ensuring funding for the four years given the nested project is two years in duration. All of the primary data will be collected in the overarching project, and the cost for data analysis and reaching out to stakeholders will be minimal, with threesupervisors there will be support throughout for the student.   

All supervisors have a history of working in Uganda and globally with local research teams, as do both SGUL and LSHTM providing institutional support in country. This project has a high likelihood of success given the local support and importance of AMR. There is an overall supportive culture for researchers and their career outside the current supervisors, which include researchers in Uganda and London who are involved in the overarching project who will support this work given the importance both locally, nationally and internationally.

Further reading

(Relevant preprints and/or open access articles)

Additional information from the supervisory team

  • The supervisory team has provided a recording for prospective applicants who are interested in their project. This recording should be watched before any discussions begin with the supervisory team.
    Sadiq-Moore-Holt-Lindsay Recording

MRC LID LINKS