Harnessing One Health Paradigm: Mobile App based AMS Implementation

• Strengthen AMR surveillance using a One Health approach, employing research-based molecular techniques to unravel potential transmission dynamics within communities.
• Measuring Antibiotic consumption in humans, animals and environment. 
• A mobile app-based solution designed to increase awareness and knowledge within communities, facilitating user-oriented and efficient implementation of antimicrobial stewardship interventions.

Principal Investigator Name- Dr Namita Jaggi (MBBS, MD)

Designation- Chairperson-Labs & Infection Control, Chief-Education & Research

Organization- Artemis Hospital, Sector-51, Gurgaon, India

Expertise- Microbiology, Infection Control and AMR research 

The development of Antimicrobial resistance (AMR) is inherently linked to the inappropriate use of antibiotics in all One Health segments i.e. human, animals and environment. Between 30% to 90% of consumed antibiotics are excreted in urine and feces, accumulating in soil, water, and plants. This accumulation leads to the emergence of AMR due to the selection pressure exerted on bacterial populations, subsequently facilitating transmission to pathogenic bacteria. Despite the existence of various AMR surveillance networks such as AMRSN by ICMR and the WHO-IAMM collaborative network WINSAR, which primarily focus on hospitals, published data on AMR surveillance from the community remains inadequate. Furthermore, the role of the environment and animal livestock in the emergence and transfer of antibiotic resistance genes (ARGs) has largely been unexplored. Therefore, it is crucial to assess each of the three components of One Health to accurately gauge the extent of the issue and devise appropriate antimicrobial stewardship measures.

Our target audience for AMR surveillance in one health project will be community residents, pharmacy retailers, veterinary practitioners, animal handlers, agro products retailers and farmers. They often have poor access to resources for understanding the emergence and transmission of AMR in the One Health space. Therefore, awareness training and education need to be imparted to practice appropriate use of antimicrobials in their specific roles and facilitate the prevention of AMR development. Training modules shall be based on assessment of their existing knowledge by enrolling them for the program through the mobile app (a user friendly model).

Our focus objective is to provide them the required tools to digitally empower them to contribute in improving the overall situation of increasing AMR in all One health categories. 

The control of AMR is possible only when there is data available on magnitude of the problem and it is communicated to the stakeholders to bring the change. We aspire to achieve optimised use of antimicrobials in the one health world as an outcome of our solution. An increase in knowledge about the multiple side effects of antibiotics, their role in AMR development and the approaching post antibiotic era would definitely uplift the judicious use of antimicrobial agents and eventually benefit the AMR situation.

The participants in our study will be sourced from different segments of the community and thereby would possess diverse educational qualifications and belong to varied socio-economic strata. Hence, if we are able to create a change in their mindsets and behaviour of antibiotic use, it will surely exhibit an extremely tangible impact on their livelihood and a great contribution to the society in combating AMR battle.

The impact over the next year will be assessed in the study population on the basis of the changes in antibiotic consumption as a result of education interventions conducted in community on appropriate antibiotic use. Scaling up the program geographically will include its expansion to nearby states and eventually PAN India. If the program reports sustenance in its performance, we believe that after 3 years, there would be a significant reduction in trends of AMR rates and antibiotic consumption patterns in various categories of One Health. AMR trends will be determined for the ESKAPE pathogen list (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.).

By evaluating the changes in antibiotic consumption and awareness levels in the community. Both the indicators will be measured by the data recorded in the mobile app, analysed and any statistically significant change will be considered a positive impact.

Our pilot project in community reported positive change in terms of knowledge, attitude and practices. In practice, the data reported 3.47% increase in consulting a doctor before taking antibiotic. After taking 2-3 doses of prescribed course, people showed improvement by 1.12% in completing the full course, 5.9% decrease in discarding leftover medications and no change for stopping the treatment in middle.

Currently, there are financial and logistic barriers to execute the study plan in the journey towards goal accomplishment. As the study is presently confined to a limited geographical area we have lesser challenges but when we plan to expand its horizons into various states in India the barriers will increase. Hence, 3 years since now, we anticipate to face challenges with regards to manpower, financial resources, language barriers for animal handlers and farmers, and information technology support to create a broader data pool. Additionally, advanced methods of data analysis would be needed to generate significant information out of the data.

Upon receiving funding resources, we would able to overcome the challenges of present and future in all the mentioned areas. For example, Local workers can be employed in the project to address the education gaps, beliefs and language barriers to communicate with the villagers, animal handlers etc.

• To seek collaborators and/or Investors
• Be a part of global network and avail opportunity to exchange knowledge and information
• Funding from an internationally recognised body like Trinity would open doors for other funding opportunities as well
• To create a social change   

As per the need of this project, we would require collaboration with experts in bioinformatics, statistics and information technology applications for their specific role in development of the solution.