Studies conducted during the baseline phase of the ViParc project have highlighted the role of veterinary drug shops as key stakeholders in antimicrobial stewardship. Owners and staff working in veterinary drug shops are gatekeepers of antimicrobial use (AMU), since they often are the first point of contact to farmers when their flocks/herds experience disease, and have considerable influence over farmers’ AMU behaviour. We estimate that >80% antimicrobials are procured through drug shops in Vietnam. The remainder corresponds to antimicrobials procured directly by integrated companies in large and industrial-scale farming settings.
Therefore, engaging veterinary pharmacists is critical to achieve sustainable, measurable, large-scale reductions in AMU in small-scale farming systems. Furthermore, reaching out to veterinary drug shops is more feasible (and cost-effective) than reaching out to a large number of small-scale farms. In Dong Thap province, for example, there are ~330 veterinary drug shops (terrestrial animals), compared with ~150,000 small-scale pig and poultry farms. Notably, the greatest reductions in AMU during the intervention phase of ViParc were recorded in farms where there was an effective liaison between ViParc Project Vets and veterinary drug shop owners.
On-site training veterinary pharmacists through Roadshows
All 330 veterinary drug shop owners and their staff (600 persons) in Dong Thap will be invited to attend a series of training workshops that will be delivered in a location close to them. These training sessions will be delivered as a ‘roadshow’ that will involve visiting several sites in the province by a team of trainers and faciliators. Trainers will include microbiologists, veterinarians, medical doctors and researchers and aims to train and engage veterinary pharmacists on the issue of AMU/AMR. Travelling to multiple sites across the province in order to enable attendance of such a large number of people is logistically complex, and will require the use of pre-recorded material (in the form of video webcasts). Training sessions will be conducted in small groups (40-50); therefore a total of 14 sessions are required to reach all 600 participants. The training materials are currently being developed by Oxford University Clinical Research Unit (OUCRU) in collaboration with the Food and Agriculture Administration of the United Nations (FAO) as well as the University of Can Tho and some industry partners. Each session will be delivered in a maximum of 2 hours. The first roadshow is scheduled for July 2020, and will include the following topics: (1) Introduction speech by the Director of Sub-Department of Animal Health and Production of Dong Thap; (2) Current legislation about antimicrobials and AMR as well as the Vietnamese National Action Plan to control Antimicrobial Resistance for Vietnam (with the input of FAO) (3) The problem of excessive AMU; impact of AMR in humans and animals (with the input of medical experts from the Hospital of Tropical Diseases, Ho Chi Minh City); (4) Introduction to the WHO list of critically important antimicrobials; (5) Practical measures to control diseases and reduce AMU on pig and poultry farms (with input from poultry and pig health experts from FAO and the University of Can Tho); (6) Use of alternatives to antimicrobials to improve productivity and enhance immunity of herds and flocks (in collaboration with EW Nutrition and Phileo-Lesaffre two large animal nutrition companies). Each topic will be delivered in 10 minutes, followed by 5 minutes’ discussion. The first roadshow will be also an opportunity to get feedback from the vet drug shop owners/staff in order to plan training contents for the second and third road shows (to be scheduled in September/October and December/January 2021). In addition, attendants of the first training session will be invited to participate in a study involving collecting a rectal swab where to be investigated for phenotypic resistance in commensal Escherichia coli. Results will be presented aggregated and anonymized during the second road show, and are expected to increase the veterinary pharmacists’ awareness about excessive AMU and AMR. For the second and third rounds of training, we plan to include specific workshops about postmortem and diagnosis of pig and poultry diseases, develop some support materials (including leaflets and videos on biosecurity, cleaning and disinfection and flock/herd management).
Providing evidence of changes in AMU/AMR
Levels of AMU/AMR in animal production in the province will be measured before and after the implementation of the training intervention described above. A random sample of 400 representative farms will be drawn from the existing provincial farm census to measure changes in AMU/AMR before and after the intervention. From each species raised (chickens, pigs, ducks) one pooled faecal sample will be collected and one Escherichia coli isolate will be recovered. In addition, data on AMU in the household will be recorded, and humans (2-3 from each household) will be invited to consent to provide a rectal swab, from which one commensal E. coli will be isolated. It is expected that a total of 800 animal E. coli and 1,600 human E. coli isolates will be collected at baseline and after the intervention (total 4,800 isolates). These isolates will investigated for their antimicrobial susceptibility against a panel of 16 antimicrobials commonly used in humans and in animal production in the area. The main outcome of this project will be a comparison in levels of AMU as well as phenotypic levels of AMR in each of the species.