One Health Genomic surveillance, Antimicrobial access data & free App

Genomic surveillance of carbapenem resistant E. coli and K. pneumoniae  isolated from human (pregnant women presenting with UTI), live-stock and sewage to map resistance and virulence across regions and climatic extremes. NGO will educate and collect antimicrobial access data. Film-maker to motivate communities. Stewardship promoted by free mobile application.

Dr Meher Rizvi, Associate Professor, Sultan Qaboos University,  Principal Investigator, DASH to protect antibiotics https://dashuti.com/, which spans Indian subcontinent, MENA,  Benin, SHEA Ambassador 2021 & ASM Ambassador 22-24,

Existing data, including work by our team, indicate LMICs may bear a disproportionately high burden of AMR. However, genomic surveillance of antimicrobial resistance (AMR) and virulence (to assess cost of fitness) in Gram negative bacilli in human, animal and environmental sectors is sparse and fragmented in LMICs making it difficult to understand the scale of the problem, transmission dynamics and identify effective interventions. 

 Estimation of how extremes of temperature and humidity impact AMR across regions is lacking. 

At the policy level, lack of adequate representative data fails to propel effective legislation to curb AMR. At the local level, laboratory data are needed to support  evidence based recommendations which clinical decision support systems (CDSS) can provide. However, most healthcare facilities do not have CDSS or mobile applications. Technology support from HIC are limited.

The potential of NGOs to education to promote healthy behaviour and utilise teachers to collect  data for mapping of  antimicrobial access data are lacking.

Power of narrative driven stories in local languages in catalysing behaviour change remains unexplored. 

 Unless we work in concert on the one health platform, leverage technology, establish meaningful partnerships with the community and interdisciplinary teams in hospitals, AMR will wreak high casualties in LMICs.

Target groups: Health Care Workers (HCW) in Human and animal healthcare sector, pregnant women attending hospital and PHC ANCs. Communities (adults and children) and antimicrobial access data through teachers (NGOs) and residents (PHCs), local and national governments. 

Support: CRE genomic surveillance in human, animal and environment for mapping resistance. Antimicrobial access data will improve distribution. HCWs through free mobile application. Healthy and informed communities (education through prepared modules), short documentaries (vernacular languages) will catalyze behaviour change, 

Need assessment: Analysis of  questionnaires will provide insight into their knowledge, awareness, practice (KAP) and tailor education. 

Engagement: Education imparted to the community, PHC, doctors and veterinarians is invaluable in responsible antimicrobial prescription and use.  Focused antibiograms, a rarity in LMICs will promote evidence based antimicrobial prescribing. The free Firstline mobile application will sustain the impact by providing a user-friendly and portable resource for healthcare providers.

Inform Policy: Data on antimicrobial access, innovative use of NGOs and PHC staff and collaboration with socially conscious documentary makers will inform new approaches in tackling AMR and gather important data.

Mapping Genomic surveillance of human, animal and environmental origin CRE E. coli and K. pneumoniae will be instrumental in informing policy.

Our initiative will  furnish the much needed genomic surveillance data which will inform the scale and nature of the problem, hot spots of resistance as well as emergence of novel resistance markers to inform future policy. Our surveillance genomic data from 40 centres  spread across India, Pakistan and Bangladesh, Benin, a centre in Africa will map the resistance and virulence among Gram negative bacilli isolated from UTI. Fitness cost of AMR genes will be assessed. The translation of this knowledge to stewardship efforts at the local level and inform policy at the regional and national level will be the second public good emanating from it. The mobile app will empower healthcare and veterinary professionals with the tools and insights needed to combat antimicrobial resistance effectively. The community outreach programme and app will enable the citizens to actively participate in mindful antimicrobial usage and better health. We expect to have several publications in peer reviewed journals By leveraging the latest advances in mobile technology and data analytics, we aim to contribute to the global efforts to preserve the effectiveness of antimicrobials and safeguard public health. 

The multimodal interventions will impact the  healthcare providers, patients, communities, local and national governments,  and even the curriculum. Insights derived from genomic surveillance will directly impact antimicrobial stewardship programs, infection control measures, and public health interventions aimed at mitigating the spread of AMR. The mobile app will serve as a comprehensive solution for AMR containment, empowering healthcare professionals with the tools and insights needed to combat antimicrobial resistance effectively. The community interface will be in vernacular languages which will have greater impact on behaviour change. By leveraging the latest advances in mobile technology and data analytics, we aim to contribute to the global efforts to preserve the effectiveness of antimicrobials and safeguard public health.

Our outreach programme with a few NGOs which  targets local communities including school children will change perceptions regarding antimicrobial usage and infection prevention and control.  Our questionnaires will promote reflective and not reflexive antimicrobial prescribing and they can be used as templates about how antibiotics should be taught and assessed among medical and veterinary students and pharmacists. We believe our questionnaires and the targeted education  of the nurses, patients and the community will promote engagement and ownership of the programme. 

First year: Consolidate antimicrobial and diagnostic stewardship efforts with the existing partners and focus on animal health, environment and community outreach. Provide a basic free mobile App to all (human and animal) partnering healthcare centres by Firstline.

Genomic surveillance and bioinformatic analysis of representative CRE samples from each centre will be initiated and a systematic heat map spanning human, animal and environmental health across regions built. 

WGS and mobile application platforms will be refined based on emerging best practices in genomic surveillance and digital health. Collection of antimicrobial access data. Add AWaRe guidance in additional languages as it is made available by WHO. Add additional mobile features as they are made available by Firstline. 

Next Three Years

Continue above work.

Implement robust data management systems and security protocols to ensure the integrity, confidentiality, and privacy of genomic and clinical data collected through our platforms. 

Develop training programs to support healthcare professionals in effectively utilizing technology for AMR surveillance, antimicrobial stewardship.

Develop narrative driven short films in vernacular languages.

Offer online webinars, and workshops on genomic epidemiology, bioinformatics analysis. 

Advocate for evidence-based policies and regulatory frameworks supporting integration of genomic surveillance and digital health technologies into national and global AMR strategies.

1. WGS Data Metrics:

Number of isolates sequenced 

Detection of resistance genes: Quantify the number and types of antimicrobial resistance genes detected 

Transmission events: Monitor the occurrence of transmission events between communities and regions through phylogenetic analysis of genomic data.

2. Mobile App Utilization Metrics:

Number of installations: Track the adoption and dissemination of the mobile app among healthcare professionals and locations .

Active users and engagement: Measure the frequency of app usage, and engagement metrics such as time spent on the app, and content utilization.

Feedback and satisfaction: Solicit user feedback through surveys, ratings, and reviews to assess user satisfaction, usability, and perceived utility of the app.

Impact on Clinical Practice:

Reduction in inappropriate antimicrobial prescribing

Improved patient outcomes

3. Community Outreach and Education:

Awareness and knowledge levels: Measure changes in awareness, knowledge, and attitudes regarding AMR among healthcare professionals, patients, and the general public through surveys, focus groups, and educational interventions.

4. Long-Term Impact:

Monitor trends in antimicrobial resistance: Track changes in antimicrobial resistance patterns over time, including shifts in resistance prevalence, emergence of new resistance mechanisms, and effectiveness of interventions.

1. Financial Constraints hinder acquisition of WGS equipment, development of mobile applications, and community outreach activities.

Strategy: Seek funding opportunities from governmental agencies, research grants, philanthropies,

1. Poor  technological infrastructure:  low-speed internet access, unreliable power supply, and laboratory facilities,

Strategy: Deploying mobile solutions that are compatible with low-bandwidth environments. Utilize cloud-based computing resources for data storage and analysis to overcome limitations in local infrastructure.

1. Insufficient trained personnel with expertise in genomics, bioinformatics,

Basic work will be carried out in each centre.  Will outsource WGS and mobile application development due to lack of funds and expertise.Invest in workforce development through training programs, workshops, and capacity-building initiatives.

Regulatory requirements, data privacy concerns, and ethical considerations surrounding genomic data sharing and mobile health interventions

Strategy: Engage with regulatory authorities, ethics committees, and legal experts to navigate regulatory frameworks and ensure compliance with data protection laws. Develop robust data governance policies, informed consent procedures, and security measures to safeguard patient privacy and confidentiality.

 Cultural beliefs, language barriers, and distrust of healthcare systems:

Strategy: Tailor communication strategies and educational materials to address cultural sensitivities, linguistic diversity, and health literacy levels within target communities. 

Trinity Challenge has come at a very timely moment of our journey as a multicentric study, as we are expanding our work into the One Health Platform.

Since our study is an international study, spanning several countries, assistance from Trinity Challenge will go a long way in consolidating our gains and expand our work.  It will provide access to a network of leading organizations, experts, and resources dedicated to addressing AMR, which will be most valuable. This mentorship will allow us to improve on our ideas and enhance our implementation capabilities, collaborative  and communication skills.

The Trinity Challenge fosters collaboration among academia, industry, governments, and non-profit organizations, creating opportunities for synergistic efforts and knowledge sharing. We have tried to do that and hope to achieve our objectives with Trinity's support.  

 Trinity Challenge will make it possible for us to make a tangible impact on global health outcomes and influencing policies and practices in the field.

Wellcome: Guidance and mentoring will be invaluable. Collaborating with them can provide access to cutting-edge expertise in AMR, which can greatly enhance the quality and impact of our work.

Bill and Melinda Gates Foundation.  Collaborating with them can provide access to funding opportunities, grants, and other resources to support

University of Cambridge. Collaborating with University of Cambridge will provide us  access to cutting edge facilities, enabling us to conduct high-quality research and experimentation to advance our understanding of AMR and develop new strategies for its prevention and control. We would appreciate free technical assistance and training and workshops. 

Imperial College, London. By collaborating with Imperial College, we could benefit from their interdisciplinary research teams and leverage their diverse skill sets and perspectives to develop innovative solutions and interventions for combating AMR. We would appreciate free technical assistance and training and workshops. 

The Behavioral Insights team. We would appreciate training sessions with them to learn strategies in bringing about appropriate behaviour change.

Facebook. Social networking will assist in generating interest and awarenness.