CAPTURA Regional Workshop Proceedings (28-30 June 2022, Virtual).

In response to the global threat of antimicrobial resistance (AMR), the Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project worked with microbiology laboratories, pharmacies, and local governments in South Asia and Southeast Asia to expand the volume of historical and current data available on AMR and antimicrobial use and to identify gaps in data and areas for quality improvement. When the CAPTURA project completed its country-level engagement in the first half of 2022, the consortium brought together local, regional, and global AMR stakeholders for a virtual regional workshop to review data outputs from the project and share strategies to inform national and regional efforts to combat AMR. This paper summarizes the main topics presented in the workshop held from 28 to 30 June 2022. As such, it highlights lessons learned from the project and strategies to fight AMR. Although CAPTURA has been invaluable to countries and information from the project is already being used, barriers concerning data quality and sharing remain. Regional-level initiatives should continue to build on the momentum gained from the CAPTURA project in supporting national-level surveillance and data quality improvements to inform critical decisions around planning, policies, and clinical care. Project findings have highlighted that issues with antimicrobial resistance and use are wide ranging across countries. Going forward, building on the current foundations and tailoring approaches to meet local needs and capacities will be fundamental in combatting AMR

WHO's essential medicines and AWaRe: recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections.

The WHO Model List of Essential Medicines (EML) prioritizes medicines that have significant global public health value. The EML can also deliver important messages on appropriate medicine use. Since 2017, in response to the growing challenge of antimicrobial resistance, antibiotics on the EML were reviewed and categorized into three groups: Access, Watch and Reserve, leading to a new categorization called AWaRe. These categories were developed taking into account the impact of different antibiotics and classes on antimicrobial resistance, and the implications for their appropriate use. The 2023 AWaRe classification provides empiric guidance on 41 essential antibiotics for over 30 clinical infections targeting both the primary health care and hospital facility setting. A further 257 antibiotics not included on the EML have been allocated an AWaRe group for stewardship and monitoring purposes. This article describes the development of AWaRe focussing on the clinical evidence base that guided the selection of Access, Watch or Reserve antibiotics as first and second choices for each infection. The overarching objective was to offer a tool for optimising the quality of global antibiotic prescribing and reduce inappropriate use by encouraging the use of Access antibiotics (or no antibiotics) where appropriate. This clinical evidence evaluation and subsequent EML recommendations are the basis for the AWaRe antibiotic book and related smartphone applications. By providing guidance on antibiotic prioritization, AWaRe aims to facilitate the revision of national lists of essential medicines, update of national prescribing guidelines and surveillance of antibiotic use. Adherence to AWaRe would extend the effectiveness of current antibiotics while helping countries to expand access to these life-saving medicines for the benefit of current and future patients, health professionals, and the environment

Love in the time of aging: sociological reflections on marriage, gender and intimacy in India

Drawing from a group of older and middle-aged (50 years above) women and men who have re-partnered (includes both marriage and cohabitation) through the assistance of a marriage bureau based in the city of Ahmedabad (Gujarat, India), we examine the sociological notions of relatedness and the “practices” of family and intimacy. We ask whether this “non-normative” process of becoming kin in the post-reproductive lives of these participants, holds promise for a democratization of the private sphere as noted by Giddens (1992) where the social process of relatedness is privileged over its biological/procreational forms. In the process, we examine how our study participants tend to organize their newly established relationships through contradictory tensions of negotiations, commitment, social obligation and personal autonomy. In-depth interviews conducted in a dyadic format revealed gendered expressions of personhood, intimacy and sociality. For example, men expected their relationship to bring in nostalgic ideals of domesticity, whereas women associated re-partnering with increased social status, kinship support and economic security underscoring the expected social benefits associated with caste-endogamous idealized heterosexual unions. Significantly, caste relations were instrumental in determining partner preferences and relationship formation with family members among older couples. We show that despite being circumscribed by conventional social scripts, women in these relationships use their (post-reproductive) age to an emancipatory advantage by bargaining with patriarchal compulsions of verilocality and lack of say in partner decisions. In a context where cultural norms prescribe a social pathology of asexuality and familial dependence in later life, this new form of relatedness offers an uplifting narrative of self-disclosure and intimacy, although ultimately reproducing social, economic and symbolic hierarchies of gender and generation.by Tannistha Samanta and Sini Susan Varghes