The growing problem of antimicrobial resistance (AMR) is threatening to undermine the advances achieved through priority health programs, including tuberculosis, malaria, acute respiratory infections, sexually transmitted infections, and HIV/AIDS, by rendering currently available treatments ineffective.

In response to this growing challenge, the U.S. Agency for International Development Bureau for the Latin America and Caribbean Region has proposed the South American Infectious Disease Initiative (SAIDI). SAIDI is a subregional strategy for the Andean countries and Paraguay. The initiative’s general objective is to contain the emergence and spread of AMR by improving the availability and use of antimicrobials of assured quality. SAIDI’s central focus is rational use of antimicrobials and AMR control. The initiative emphasizes preventing the emergence of multidrug-resistant tuberculosis.

Since 2004, the Rational Pharmaceutical Management (RPM) Plus Program, predecessor to Management Sciences for Health’s (MSH) current Strengthening Pharmaceutical Systems (SPS) program, and SAIDI international partners, including the Alliance for Prudent Use of Antibiotics, U.S. Pharmacopeia’s Promoting the Quality of Medicines Program (PQM), Links Media, U.S. Centers for Disease Control and Prevention, and Pan American Health Organization’s Infectious Disease Division, have been working with national counterparts in Bolivia, Peru, and Paraguay to create a new evidence-based and stepwise approach to local solutions for containing AMR. This approach considers factors contributing to AMR within the context of existing systems rather than in isolation, taking advantage of the interactions among stakeholders.

Over the past three years, national AMR working groups have been formed in Peru and Paraguay in conjunction with SAIDI international partners and have conducted various assessment activities that have led to a holistic local view of the factors contributing to AMR in Peru, Paraguay, and Bolivia. Based on these results, MSH, through the RPM Plus and SPS Programs, and national partners have implemented activities to address problem areas, including—

• Certification of DISA Callao warehouse in Good Storage Practices (Peru)
• Development and implementation of standard operating procedures for second-line tuberculosis medicines (Peru)
• Establishment and strengthening of a network of Drug Information Centers (Peru and Paraguay)
• Communication campaigns targeting prescribers, dispensers, and patients (Peru and Paraguay)
• Pharmaceutical management capacity building (Peru and Paraguay)
• Improvement of facility-level management of first-line tuberculosis medicines (Paraguay and Bolivia)

Since 2010, SAIDI partners have been focusing on a holistic and participatory approach in controlling multi-drug resistant tuberculosis (MDR-TB) in the Peruvian region of Madre de Dios. Located in the Amazon Basin, this region has the highest rates of MDR-TB in Peru. The most vulnerable population are artisanal gold miners living in temporary camps within remote areas and have no access to health services.

Using the SAIDI approach, SPS participated in a workshop held in March 2011 where local authorities, TB patients and technical cooperation agencies agreed on a plan for the control of MDR-TB in Madre de Dios (download report in Spanish). Following this plan, SPS continues to provide technical assistance in designing a pharmaceutical supply system suitable to local conditions, particularly in the mining areas.