Empowering Communities Against AMR - Data-Driven One Health Solution

It leverages data and technology for a community-centric response to antimicrobial resistance. Integrating clinic, lab, and citizen databases, it enables real-time surveillance, mapping antibiotic use, combating falsified drugs, enhancing biosafety, and educating stakeholders. This innovative One Health solution empowers communities and informs policies for sustainable antimicrobial stewardship.

Dr Mumtaz Ali Khan, Chief CDC-NIH, National Institute of Health, Pakistan

The specific problem addressed by the solution is the alarming rise of antimicrobial resistance (AMR), threatening health, food security, and the environment. Globally, AMR results in an estimated 4.95 million deaths annually, with 1.27 million directly linked to antibiotic resistance. If unchecked, this toll could surge to 10 million deaths yearly by 2050. In low- and middle-income countries (LMICs), where data gaps persist, the impact is particularly severe.

In Pakistan, for example, AMR is a growing concern due to factors such as inadequate surveillance, widespread antibiotic misuse, and limited access to quality healthcare. The overuse of antibiotics in human and animal health, agriculture, and poor waste management contribute to the rise of resistant strains.

The scale of the problem is substantial, affecting millions in LMICs and posing a significant threat to vulnerable populations. In Pakistan, a lack of community-level data exacerbates the challenge. The causes include inadequate surveillance infrastructure, weak regulatory measures, and insufficient education on responsible antibiotic use.

The proposed solution aims to fill these gaps by leveraging data and technology at the community level, promoting informed policies, combating falsified drugs, enhancing biosafety, and ensuring access to effective antimicrobials. 

The target audience for CHOICE in Pakistan includes:

1. Community Health Workers (CHWs): Empowering CHWs with mobile apps for data collection, education, and supporting their role in the surveillance system.

2. Healthcare Providers: Offering a real-time dashboard to clinicians for better decision-making, along with point-of-care testing tools for improved diagnostics.

3. Pharmacists: Integrating pharmacy data to ensure proper distribution and use of antibiotics, combating falsified drugs.

4. Farmers: Engaging farmers through educational modules on biosafety, responsible antibiotic use, and environmental impact.

5. Consumers: Providing smartphone apps to verify the authenticity of antimicrobials, promoting awareness and responsible antibiotic use.

Supporting Them:

• Improved Access to Information: Enhancing the knowledge and awareness of CHWs, healthcare providers, and farmers on AMR and responsible antibiotic use.

• Better Tools and Resources: Providing CHWs with mobile apps for data collection and education, and healthcare providers with a real-time dashboard for informed decision-making.

• Safer Agriculture Practices: Offering farmers educational modules on biosafety and sustainable farming, reducing the environmental impact of antibiotic use.

• Enhanced Medication Quality: Empowering consumers to verify the authenticity of antimicrobials, reducing the risk of substandard or falsified drugs.

Through these engagement strategies, CHOICE aims to develop a solution that directly addresses the unique needs and challenges of the target audience in Pakistan, fostering a sense of ownership and collaboration in the fight against AMR.

CHOICE provides several public goods that contribute to the global well-being and fight against antimicrobial resistance (AMR):

1. Real-time Dashboard: A free-to-use, open-sourced real-time dashboard accessible to healthcare providers, policymakers, and communities globally, offering insights into AMR cases, antibiotic usage, and falsified drug access.

2. Mobile Apps and Educational Modules: Open-sourced mobile apps for community health workers, educational modules for farmers, and smartphone apps for consumers, promoting knowledge sharing and responsible antibiotic use.

3. Data Insights and Analytics: Aggregated and anonymized data insights shared through white papers, publications, and open-sourced analytics models, contributing to global knowledge on AMR transmission dynamics.

4. Blockchain-based Tracking System: An open-sourced blockchain-based system for tracking the supply chain of antimicrobials, providing a transparent and replicable solution to combat the dissemination of substandard drugs.

5. Biosafety and Environmental Guidelines: Open-sourced guidelines on biosafety and environmental security for farming communities, aiding global efforts to mitigate the environmental impact of antibiotic use in agriculture.

6. Point-of-Care Testing Kits: Open-sourced design and protocols for point-of-care testing kits for detecting antibiotic residues and bacterial antimicrobial resistance genes, contributing to global efforts in efficient surveillance.

CHOICE, a comprehensive solution to combat antimicrobial resistance (AMR), aims to create tangible impact by addressing critical challenges faced by communities, healthcare providers, and vulnerable populations. The real-time dashboard and mobile apps empower stakeholders with data-driven insights, reducing inappropriate antibiotic prescriptions and improving overall health outcomes. The blockchain-based tracking system and smartphone apps combat the dissemination of falsified drugs, ensuring safer medication access for vulnerable populations. Educational modules for farmers and biosafety mapping contribute to sustainable agriculture and environmental well-being. CHOICE's open-sourced tools and guidelines benefit underserved communities, fostering equitable access to resources. Pilot programs and success stories provide evidence of the solution's efficacy, demonstrating its potential to make a meaningful impact in the fight against AMR.

Scaling Impact Over the Next Year:

In the coming year, CHOICE plans to expand its impact by extending pilot programs to additional regions within Pakistan. By collaborating with diverse communities, the solution aims to gather valuable insights and optimize its functionality based on real-world usage. Strategic partnerships with local healthcare organizations, NGOs, and governmental bodies will be forged to integrate CHOICE into existing health systems, ensuring widespread adoption. Comprehensive training programs will be implemented to empower healthcare providers, community health workers, and farmers, enhancing their understanding and utilization of CHOICE tools. 

Scaling Impact Over the Next 3 Years:

Over the next three years, CHOICE envisions national integration within Pakistan by working towards incorporating the solution into national health policies and frameworks. The goal is to secure government support for scaling CHOICE across the country. Simultaneously, CHOICE plans to expand its impact globally by adapting the solution to other low- and middle-income countries (LMICs) facing similar challenges. Collaborations with international organizations, academic institutions, and industry partners will be established to create a global network focused on addressing antimicrobial resistance through data-driven solutions. Through capacity building, CHOICE will develop training modules for healthcare professionals and community workers.

Monitoring and evaluating the impact of CHOICE is pivotal to ensuring its effectiveness in tackling antimicrobial resistance (AMR). One key strategy involves regularly assessing the utilization of the real-time dashboard and mobile apps by healthcare providers and community health workers. This includes measuring the frequency of data updates to identify trends in antibiotic prescriptions and resistance patterns. 

A critical measure of CHOICE's impact lies in its ability to reduce inappropriate antibiotic prescriptions. Tracking the number of inappropriate prescriptions over time allows for a quantitative assessment of the solution's influence on improving prescription practices and curbing antibiotic misuse. Additionally, the effectiveness of the blockchain-based tracking system will be evaluated by assessing the reduction in access to falsified drugs. This involves monitoring the frequency of consumers using smartphone apps to verify the authenticity of antimicrobials, providing tangible evidence of CHOICE's role in ensuring safer medications.

Lastly, the effectiveness of training programs will be assessed by measuring the competency and confidence levels of healthcare professionals and community workers in utilizing CHOICE tools. The successful implementation of educational modules will serve as an indicator of CHOICE's ability to empower stakeholders with the necessary knowledge and skills.

CHOICE acknowledges several barriers that may limit its impact, including inadequate infrastructure, education gaps, financial constraints, policy challenges, cultural resistance, market competition, and legal considerations. To mitigate these barriers, CHOICE plans to collaborate with local telecom providers to enhance network coverage and develop offline functionality. Comprehensive training programs will bridge digital literacy gaps, while partnerships with NGOs and governmental agencies will address financial constraints. Advocacy efforts and policy alignment will navigate regulatory challenges, and culturally sensitive approaches will be adopted to overcome behavioral resistance. CHOICE aims to differentiate itself in the market through tailored solutions and user-friendly features. Resources will be strategically utilized through partnerships, advocacy, and community engagement to ensure the viability and success of the solution in addressing antimicrobial resistance.

CHOICE is applying to The Trinity Challenge to leverage its expertise and resources in addressing the urgent global issue of antimicrobial resistance (AMR). The challenge aligns with CHOICE's mission to combat AMR at the community level, particularly in low- and middle-income countries. The Trinity Challenge offers a unique opportunity for CHOICE to enhance its impact by providing access to a network of global experts, addressing data and analytics gaps in LMICs, and overcoming infrastructure challenges through collaborative partnerships. Joining The Trinity Challenge enables CHOICE to contribute to a global ecosystem dedicated to tackling AMR, fostering collaboration, and gaining validation for its efforts. By participating, CHOICE seeks recognition, credibility, and the support needed to navigate complex challenges and make meaningful contributions to the fight against antimicrobial resistance on a global scale.

Drug Regulatory Authority of Pakistan (DRAP)

THL, Finland 

US-CDC