MINIMIZE: Mitigating Needles(s) Micro-Epidemics

MINIMIZE is building a block systems model to represent the movement and supplies of syringes, instantiating it with real-world data, and solving it (using PDEs, percolation, MC simulations) to  predict impending outbreaks caused by syringe reuse.  The goal is to prevent and mitigate the horrific tragedies of micro-epidemics.

Prof. Ravi Sundaram, Professor Khoury College of Computer Sciences will be Primary Investigator leading a team comprised of Profs Nikos Passas, Mansoor Amiji, Muhammad Zaman and Ioannis Kakadiaris.

On March 31st, 2021, the New York Times featured a heartbreaking story of an uncontrolled epidemic of HIV in the town of Ratodero, Pakistan, affecting innocent young children. Thousands of children there are now facing near-certain death because they contracted HIV from syringe reuse. 

Needles, cannulae, and syringes are sterile, single-use items. However, the reuse of needles and syringes is all too common around the world. Each year, 16 billion injections are given in the developing world and it is estimated that 6.7 billion are done with reused equipment. The regions most affected by needle reuse are Africa, Eastern Mediterranean Europe and Southeast Asia. 

Our goal is to prevent harm caused by scavenge and reuse of needles. 

Though, the problem is complex involving corruption, drug abuse, inadequate enforcement etc., the core of the problem is a lack of access to safe, sterile equipment leading poor communities in developing regions to scavenge and reuse. It is a moral imperative for the leading manufacturers of the world to both provide adequate supply as well as means for safe and secure disposal of used equipment. We will  help direct their efforts by predictively identifying areas in need of assistance and aid.

The target audience is manufacturers of syringes/needles (e.g. Becton Dickinson, Braun Melsungen, Terumo, etc.,) and healthcare organizations in developing countries such as Pakistan (e.g. Aga Khan University Hospital) and Uganda (the three Medical Bureaus).  Our ultimate beneficiaries are the poor and vulnerable sections of society in developing countries with limited healthcare access. We are working with BD and healthcare organizations in Pakistan to understand the supply chain for syringes and needles. By engaging the CSR (Corporate Social Responsibility) arms of these institutions we will develop tools for predicting the rise in levels of reuse that could lead to outbreaks such as the HIV outbreak in Ratodero, Sindh. 

Our project will generate the following public goods:

1. direct public health outcomes in terms of prevented and mitigated outbreaks and disease spreads due to needle reuse

2. compilation of comprehensive datasets on needle reuse

3. research papers on functional block models, stochastic block models and network analysis

4. courses and research projects for students

Our ultimate beneficiaries are the poor and vulnerable sections of society in developing countries with limited healthcare access. We are working with BD and healthcare organizations in Pakistan to understand the supply chain for syringes and needles. By engaging the CSR (Corporate Social Responsibility) arms of these institutions we will develop tools for predicting the rise in levels of reuse that could lead to outbreaks such as the HIV outbreak in Ratodero, Sindh.

In year one we will collect the data, build the model, fit the parameters and validate using back-tests.

In year two we will develop predictions for the province of Sindh in and around peri-urban areas such as Ratodero. By liaising with local NGOs we will distribute solutions in terms of medical supplies, waste management equipment as well as educational interventions.

In year three we will look to roll out our predictions and pilots to the entire province of Sindh which has a population of 50 million.

Here are the metrics we will be collecting: 

1. Number of predictions - positive and negative

2. Accuracy of predictions - we expect that we will naturally have controls since the scarcity of resources will automatically force us to provide interventions only for a subset of the regions with positive predictions.

3. Number of people directly affected

4. a) Size and comprehensiveness of compiled dataset b) Number of research papers published c) Courses taught and students graduated.

The two main barriers are 1. funding to keep the initiative alive and supported. We have a planning grant from the NSF and will be applying for a bigger grant but any support we can get from Trinity will be crucial and 2. buy-in from the private (Becton Dickinson) and public sectors in countries such as Pakistan and Uganda.

Northeastern University: Ravi Sundaram, Mansoor Amiji and Nikos Passas

Boston University: Muhammad Zaman

University of Houston: Ioannis Kakadiaris

Trinity Challenge can help us overcome the cost barrier by providing funding to grow our initiative into a scalable and impactful effort. It can help us overcome the issue of buy-in by providing credibility with  private and public partners. 

Becton Dickinson, Adam Zirda - we have an ongoing relationship thanks to Trinity Challenge

Dr. Evidence, Todd Feinman - we have an ongoing relationship thanks to Trinity Challenge