Digital case discussion provides effective education on anti-microbial resistance in low- and middle-income countries.

Antimicrobial resistance (AMR) is one of the greatest threats to global health (WHO)1 and has substantial economic implications particularly in low and middle-income countries (LMICs).2 It is estimated that in 2019, 4.95 million deaths globally were associated with bacterial AMR, with the greatest burden being borne by countries in western sub-Saharan region.3 Healthcare professionals (HCPs) play an important role in addressing AMR. In 2015, the WHO implemented a Global Action Plan, noting that significant HCP knowledge gaps exist, and are hampering efforts to reduce AMR,4 with numerous studies showing these gaps in LMICs. Education on antimicrobial stewardship (AMS) is a key part of the WHO policy.4-7 Methods This 6 month program used the MedShr (MEDSHR Ltd. UK) global clinical case discussion network to deliver education on AMR and AMS to HCPs in LMICs. MedShr is a professional network that connects over 2.5 million doctors and HCPs globally through clinical case discussion and peer to peer learning. The platform is free to use and available via native apps and on web, working in partnership with over 200 national and specialist medical societies, and is established as a secure and trusted platform in LMICs. Learning Objectives: 1. Describe the impact of AMR on global public health, including increased morbidity, mortality, and healthcare costs. 2. Identify factors contributing to the emergence and spread of AMR, including inappropriate antimicrobial use. 3. Discuss the challenges posed by antimicrobial use in vulnerable populations and resource-limited settings. 4. Outline the roles and responsibilities of HCPs in AMS and promoting responsible antimicrobial use. The program used the following educational content targeted at HCPs in LMICs with a focus on sub-Saharan Africa: 1. 12 Featured Educational Cases, created by MedShr's clinical team with subject matter experts 2. Two online Learning Modules using longer form content with multiple choice questions to engage learners 3. AMR Education Group hosted and moderated on MedShr to cohort educational content Results The program reached 244,520 HCPs in the target audience with 75,537 engagements with the educational content (Figure 1). The responses to poll questions by HCPs before and after the program showed improvement AMR knowledge including: the role of E Coli AMR (increased by 45%); identification of the characteristics of viral compared to bacterial infections (increased by 10%); and understanding of the role of overprescribing in AMR (increased by 13%) (Figure 2). Conclusion This program demonstrates the effectiveness of a mobile first digital education program in improving HCP knowledge and understanding of AMR in LMICs. This program aligns with data from a prior study which showed that a short training program on AMR and AMS for HCPs in a LMIC can lead to a reduction in the prescribing of empirical and broad-spectrum antibiotics.8 Further work is in progress to extend the geographical reach of this program and to develop formal certification in AMS for HCPs in LMICs.