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Infection and Global Health Research Division

Research at the University of St Andrews School of Medicine


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COVID-19 and Antimicrobial Resistance in East Africa – impact and response

PI: Prof Matthew Holden, School of Medicine

There is a growing worry that knock-on effects originating from the response to COVID-19 will cause greater threats to human health in the future. One such area is antimicrobial resistance (AMR) caused by the overuse of antibiotics (AB).

Responding to COVID-19, governments have imposed restrictions on everyday life to stop the virus spreading. Whilst these may be successful in combating the virus, they are changing the way people seek medical help for infections, and the way in which people use ABs when they feel ill.

In order to help make sure that ABs retain their effectiveness, we need to understand more about how COVID-19 is directly and indirectly impacting on AB use and availability in communities. To do this we are going to build on existing studies in Tanzania and Uganda (HATUA) and explore three interconnected AMR domains (Figure 1).

We will enrol patients who have symptoms of common diseases caused by bacteria, and find out about how they seek treatment and get and use ABs. In their communities, we will find out about the availability of ABs by interviewing doctors and sellers of ABs, and more widely, we will find out how community members have received and responded to health messages on COVID-19. Using this information we are able to assess change in the situation by comparing with our pre-COVID-19 research information from the same locations. This will help identify where behaviours have changed and whether antibiotics are been used unnecessarily, so that steps and measures can be identified and introduced that can help communities use antibiotics more effectively, and therefore reduce the risk of increasing AMR.



Principal Investigator


Prof Matthew Holden


Pathogen Genomics, Antibiotic Resistance, Hospital-Associated Infection, Bacterial Evolution, MRSA


School of Medicine


Dr Wilber Sabiiti

Principal Research Fellow


Dr Derek Sloan

Senior Lecturer/Consultant in Infectious Diseases


Dr Alison Sandeman

Programme Manager - HATUA Consortium


School of Geography


Dr Katherine Keenan

Senior Lecturer; Director of Impact and Innovation


Dr Michael Kesby

Senior Lecturer


Miss Olga Loza


Dr Emmanuel Olamijuwon

CARE Consortium

Dr Benon B Asiimwe
Makerere University, Kampala, Uganda
Prof Stephen E Mshana
Catholic University of Health and Allied Sciences, Mwanza, Tanzania
Dr Stella Neema
Makerere University, Kampala, Uganda
Dr Joseph R Mwanga
Catholic University of Health and Allied Sciences, Mwanza, Tanzania
Dr Martha Mushi
Catholic University of Health and Allied Sciences, Mwanza, Tanzania

CARE funders

CARE is a £1M, 18-month study, that is part of the Global Effort on COVID-19 (GECO) Health Research program. The award is by the UK Department of Health and Social Care (DHSC) through the National Institute for Health Research (NIHR) and by the Medical Research Council (MRC), which is part of the UK Research and Innovation (UKRI).