1. Preventing Global Drug Resistance Rachel Nugent, Ph.D. Global Ministerial Forum on Research for Health November 20, 2008 Bamako, Mali Drug Resistance Working Group Consultation Session

9. Tripartite Framework Resistance Drug Technology Factors long drug half-life, cross-resistance, treatment length and complexity, monotherapy Behavioral Factors (Patient): poor adherence, self-medication, cultural preferences/beliefs (Provider):unclear diagnosis, financial incentives, industry promotion Health Systems Factors Poor quality, unregulated prescribing/dispensing, weak infection control, lack of rapid diagnostic tools, poor surveillance

10. Comparison of Disease-Related Resistance Issues (from the 2001 WHO Global Strategy for Containment of Antimicrobial Resistance) Issues Bacterial Infections TB Malaria HIV Inappropriate Use Contributes to ↑ Drug Resistance Yes Yes Yes Yes Need for New Drug Development Yes Yes Yes Yes Detection of Pathogen Reasonably Easy and Feasible Easy Easy Easy Detection of in vitro resistance Reasonably Easy and Feasible Feasible but Expensive Difficult, Expensive, Rarely Feasible Difficult, Expensive, Limited Availability Diagnostics Able to Detect Resistance Yes, but slow Some No Yes, but expensive and with limited availability Observed Treatment No Yes  DOTS No No Antimicrobial Treatment Single Agent, Short Duration Multiple Agents, Long Duration ≥ 1 Agent, Short Duration Multiple Agents, Lifelong HIV Interaction Some: Especially Nosocomial Risk Massive: Personal & Nosocomial Risk Possibly N/A Potential Impact of One Program on Another Yes; Some Antibiotics Could Affect Malaria Resistance Little; Except for Rifampicin Use on Staph . Spp. Some; e.g. doxycyline, sulphadoxine-pyrimethamine Yes; e.g. cotrimoxazole + isoniazid prophylaxis