The localisation process of an AWaRe-based antibiotic stewardship intervention in primary care across four low- and middle-income countries.
1
Learning & Development/Research, Knowledge Translation Unit, Cape Town, South Africa
2
Norwich Medical School, University of East Anglia, Norwich, United Kingdom
3
St George’s School of Health and Medical Sciences, City St George’s, University of London, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):A203
ABSTRACT
BACKGROUND:
Inappropriate antibiotic use contributes to millions of deaths globally each year1. The World Health Organization’s AWaRe system aims to improve antibiotic prescribing practices1. The AWaRe1 trial2, designed to test this system’s effectiveness, was initiated in four low- and middle-income countries (LMICs) - Nigeria, Indonesia, Bangladesh and Vietnam. An intervention package addressing acute respiratory illnesses (ARI) was developed from the AWaRe antibiotic book by the Knowledge Translation Unit (KTU). To enable global implementation, the package required localisation across diverse settings.
METHODS:
Components requiring localisation included a clinical decision tool, behaviour change posters, a clinician self-audit log, training presentations with case studies and quizzes, implementation manuals, and a reporting system – all first presented in English. Project management tools supported communication and document transfer between the KTU and implementation teams. Online workshops were held at key stages, collectively and per country. Implementation teams considered local health systems, policies, medication availability, disease burden and cultural context. Translation into local language occurred where required and AI-generated voices were utilised for local narration. Final materials were produced in online and offline formats, allowing for varied training settings.
RESULTS:
The AWaRe1 intervention package was successfully localised for four LMICs. All components were adapted to align with country-specific contexts, enabling future implementation of the AWaRe intervention. Key challenges included discrepancies between local medication availability and clinical guidelines, compared with AWaRe guidance; coordination with broader AWaRe1 trial activities; health system and funding related delays; variation in implementation team capacity; and internal decisions regarding digital tools and data collection requirements.
CONCLUSIONS:
This process demonstrates the feasibility of localising an AWaRe-based intervention for primary care in LMICs and establishes a foundation for a streamlined, replicable approach to adapting and implementing the AWaRe system across diverse settings. This will be evaluated during the AWaRe1 trial and accompanying process evaluation.
Inappropriate antibiotic use contributes to millions of deaths globally each year1. The World Health Organization’s AWaRe system aims to improve antibiotic prescribing practices1. The AWaRe1 trial2, designed to test this system’s effectiveness, was initiated in four low- and middle-income countries (LMICs) - Nigeria, Indonesia, Bangladesh and Vietnam. An intervention package addressing acute respiratory illnesses (ARI) was developed from the AWaRe antibiotic book by the Knowledge Translation Unit (KTU). To enable global implementation, the package required localisation across diverse settings.
METHODS:
Components requiring localisation included a clinical decision tool, behaviour change posters, a clinician self-audit log, training presentations with case studies and quizzes, implementation manuals, and a reporting system – all first presented in English. Project management tools supported communication and document transfer between the KTU and implementation teams. Online workshops were held at key stages, collectively and per country. Implementation teams considered local health systems, policies, medication availability, disease burden and cultural context. Translation into local language occurred where required and AI-generated voices were utilised for local narration. Final materials were produced in online and offline formats, allowing for varied training settings.
RESULTS:
The AWaRe1 intervention package was successfully localised for four LMICs. All components were adapted to align with country-specific contexts, enabling future implementation of the AWaRe intervention. Key challenges included discrepancies between local medication availability and clinical guidelines, compared with AWaRe guidance; coordination with broader AWaRe1 trial activities; health system and funding related delays; variation in implementation team capacity; and internal decisions regarding digital tools and data collection requirements.
CONCLUSIONS:
This process demonstrates the feasibility of localising an AWaRe-based intervention for primary care in LMICs and establishes a foundation for a streamlined, replicable approach to adapting and implementing the AWaRe system across diverse settings. This will be evaluated during the AWaRe1 trial and accompanying process evaluation.
| eISSN: | 2654-1459 |
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