GB-UKPRN-10004180-1002274 Manchester Metropolitan University Research questions: (1) How do abiotic and biotic factors influence the levels and concentrations of antibiotics and antimicrobial resistance genes (ARGs) in aquatic environments? (2) How is environmental antimicrobial resistance (AMR) linked to human and animal health? (3) How can eco-hydro wetlands be optimised to remove antibiotics (ABs), ARGs and multidrug-resistant pathogens (MDRs) from wastewater? (4) What is the economic cost of AMR? (5) How can Community Engagement and Involvement (CEI) be enhanced to reduce AMR spread? (6) What capacity can be built for sustainable research and management of environmental AMR? Background: AMR is an urgent public health problem with a serious threat to human, animal and environmental health. It is particularly severe in Low- and Middle-Income Countries due to: (1) weak and disjointed monitoring and surveillance of AMR in the environment, (2) lack of technological advances to detect, assess and remove ABs, ARGs and MDRs from the environment, (3) scarcity of data on burden and drivers of AMR and surveillance, (4) limited data on economic cost of AMR, (5) lack of awareness, knowledge and enforcement of existing legislation, and (6) weak structures and lack of skilled human capacities in AMR research. Aims and objectives: We aim to co-develop a One Health approach to mitigate and manage environmental AMR for enhancing health and wellbeing in Kenya and Uganda. Our objectives are to: (1) investigate the influence of abiotic and biotic factors on ABs and ARGs levels in aquatic environments, (2) co-design a surveillance and monitoring system to facilitate effective reduction strategies for AMR in clinical, animals and environmental settings, (3) optimise an eco-hydro wetland to remove ABs, ARGs and MDRs from wastewater in a cost-effective and sustainable way, (4) co-develop a digital AMR online hub for training, management and regulation of AMR, (5) estimate the economic cost of AMR, (6) co-design avenues of CEI for reduction of AMR, and (7) build human capacity for sustainable AMR research and management. Methods: A One Health approach is co-developed to study environmental AMR and its links to human and animal health using interdisciplinary methods such as experimental, analytical and modelling studies, field tests, microbiological assays, genome sequencing, HPLC, Artificial Intelligence, One-Health cost model and CEI strategies. Timelines for delivery: Main representative deliverables are: 1st year, capability building programme, data management plan, CEI plan, baseline data; 2nd year, modelling tool, constructed pilot eco-hydro wetland; 3rd year, links of environmental AMR to human and animal health, monitoring and surveillance system and 4th year, two constructed improved eco-hydro wetlands, digital AMR online hub, economic cost of AMR. Anticipated impact and dissemination: Anticipated impacts will be: (1) reduced levels and slower spread of AMR, (2) restored sustainable access to clean and safe water, (3) reduced impact of infectious diseases on humans, animals and plants, and (4) mitigated impact of AMR on economic development. Dissemination will be through: (1) African CDC, (2) all One-Health associated working groups in MoHs, (3) DNDi East Africa Regional Office, (4) engaged stakeholders and CEIs, (5) trained health workers, and (6) meetings/barazas, workshops, conferences, websites, policy briefs, open high-quality publications, and media publicity such as YouTube, Facebook and Twitter. Masinde Muliro University of Science and Technology Makerere University Busitema University University of Pretoria South African Medical Research Council Jaramogi Oginga Odinga Teaching & Referral Hospital Kisumu Water and Sanitation Company Limited National Environment Management Authority Public Health and Sanitation- County Government of Kisumu St. Mary's Hospital Lacor National Institute for Health and Care Research Manchester Metropolitan University Manchester Metropolitan University Eleanor Welsh Africa AMR-STOP Programme Manager e.welsh@mmu.ac.uk 854762.36 711049.60 785538.66 736537.26 9732.70 Expenditure for Manchester Metropolitan University for Q1 (Jan26-Mar26) 128697.41 National Institute for Health and Care Research 38444.81 Expenditure for Manchester Metropolitan University for Q2 (Apr26-Jun26) 193046.12 National Institute for Health and Care Research