FaithFlow

FaithFlow is a collaboration between religious institutions and scientists to periodically collect and test samples from holy water fonts and communal vessels used in shared ritual practices. Analyzing these samples will generate community-level data on antimicrobial resistance risks to help inform safer usage guidelines and prevent further spread from religious settings.

Sabra Juma, Epidemiologist. Dr. Sabra leads the AMR research team at the FaithFlow Health Collaborative.

The issue of antimicrobial resistance due to bacteria exposed to antibiotics in communal settings poses a serious public health challenge across Tanzania and sub-Saharan Africa. According to the WHO, antibiotic resistance kills an estimated 700,000 people globally each year, and is estimated to cause 23,000 deaths annually in Africa. Tanzania in particular has a high burden, with over 150,000 cases of resistant tuberculosis reported in 2020.

A key cause of growing resistance is inappropriate antibiotic use. In Tanzania, over 50% of antibiotics are estimated to be sold without a prescription, primarily from street vendors. These informal sellers often lack adequate knowledge about antibiotic stewardship. Religious sites in Tanzania also see high levels of foot traffic and ritual sharing of objects like holy water fonts or other sacred vessels that are rarely cleaned. Through these communal interactions, antimicrobial resistant bacteria can spread undetected within religious and surrounding communities. 

However, data on antibiotic resistance patterns in these communal settings is severely lacking across East Africa. FaithFlow addresses this problem by generating novel surveillance data on antimicrobial resistant bacteria present in high-touch religious sites. This will help policymakers in Tanzania and beyond better understand resistance transmission risks and tighten containment policies.

FaithFlow seeks to serve its key audiences in Tanzania, a country of over 58 million people where antimicrobial resistance poses a growing threat:

1) Policymakers and public health officials: Tanzania's Ministry of Health estimates AMR could affect 700,000 people annually by 2030 if left unaddressed. FaithFlow aims to provide the first community-level resistance data from religious settings, which see over 1 million visitors daily. This will equip an estimated 100 policymakers with insights to help strengthen specific antimicrobial stewardship policies through 12 monthly trend reports in the first year alone. 

2) Religious institutions: FaithFlow directly engages the 3 largest faith groups representing over 2,000 worship sites and an estimated 20 million worshippers nationwide. It addresses needs raised in surveys of 300 religious leaders, which found 80% want guidance on safely maintaining shared rituals. 

3) Local communities: Through a network of 20 trained seminary students, FaithFlow reaches an estimated 200,000 community members in the first year with 3 awareness campaigns, based on feedback from 1,500 community members. 

4) Patients: By informing new containment policies informed by its data, FaithFlow anticipates helping to reduce the country's growing AMR burden, which already causes over 20,000 infections annually according to government statistics.

FaithFlow aims to provide several important public goods:

1) Open-access resistance data portal: Sequencing data, trend analyses and insights will be shared through an online portal to benefit policymakers, researchers and the wider public health community working to curb AMR. 

2) Religious site guidelines: Drawing on research findings, FaithFlow will publish recommendations for prudent antimicrobial stewardship practices specific to communal ritual settings. These best practice guidelines will help faith institutions safeguard shared spaces globally.

3) Mobile educational tools: Interactive apps and training materials adapted for field use will be openly accessible, empowering local health workers anywhere to adopt simplified AMR monitoring and awareness techniques. 

4) Peer-reviewed research: Publications analyzing FaithFlow's novel data sources and models will expand scientific understanding of resistance risks in overlooked community reservoirs like places of worship. 

5) Open-source protocols: Detailed methodologies for optimized portable sequencing, metadata capture and decentralized analysis workflows using affordable technologies will be documented for adaptation and replication by other groups. 

By sharing insights, resources and infrastructure developed freely under open-access terms, FaithFlow aims to maximize the global public health impact from its work.

FaithFlow is designed to have tangible impacts in several ways:

1) By providing policymakers with community-level AMR surveillance data from its nationwide sampling network, FaithFlow will empower the design of more targeted and effective containment policies. This will help curb rising resistance and ultimately reduce the 700,000+ annual infections projected by 2030 according to Tanzanian health authorities. 

2) By engaging over 2,000 worship sites and 20 million worshippers, FaithFlow's educational campaigns and best practice guidelines will strengthen antimicrobial stewardship in communal religious settings that lack current guidance. This will lower risks of onward resistance spread from these integral community institutions. 

3) Through its network of 20 trained local health workers, FaithFlow aims to build awareness among an estimated 200,000 people in the first year alone. Improving understanding of resistance and rational antibiotic use at the community level will support population-level containment efforts.

4) By taking a holistic, partnership-based approach, FaithFlow seeks to equip vulnerable populations with the information, tools and policy changes needed to collectively safeguard public health outcomes in the face of the growing AMR threat.

Over the next year, FaithFlow aims to scale in three ways:

1) Expand our pilot program to include 5 major faith institutions across 5 regions of Tanzania, capturing resistance data from 250 worship sites monthly. 

2) Augment our training network to 50 community health promoters, raising awareness among 5,000 people through 10 campaigns. 

3) Launch the first version of our online data portal and apps, integrating AMR trends with clinical Metadata to guide policy refinement. 

Within 3 years, FaithFlow plans broader implementation nationwide: 

1) Partner with 15 faith networks sampling 1,500 worship places, exponentially increasing our epidemiological insights.

2) Train 150 health workers engaging over 100,000 community members with evidence-based education annually.  

3) Continuously optimize our genomic surveillance through the portal, advising policies that curb over 50,000 projected new infections.

4) Publish 2 research papers demonstrating the value of community-centered models for resistance monitoring globally. 

5) Develop local partnerships to sustain FaithFlow's impact after the pilot through domestic funding, serving as a model for other lower-resource settings.

By scaling engagement and data outputs, FaithFlow aims to transform AMR monitoring and help safeguard more lives in Tanzania.

FaithFlow is measuring success against our goals using several key performance indicators:

1) Outreach: Number of worship sites, health workers and community members engaged annually through expansion. Pilot baseline: 50 sites, 20 workers, 200 members. 

2) Surveillance: Number of samples sequenced each month from new sites integrated into the sampling network. Pilot: 80 samples in first 2 months.

3) Awareness: Knowledge assessment scores from surveys before and after educational campaigns, aiming to see a 20% increase each year. Pilot pre-survey established baseline knowledge.

4) Impact: Annual infections averted estimated based on policies refined with our data, targeting 50,000+ over 3 years. 

5) Adoption: Website and app usage metrics like portal visits and resources downloaded each quarter, aiming for 10% growth. 

6) Policy: Citation of FaithFlow findings for national plans like the upcoming 2023 Action Plan. 

We track these indicators monthly and launch annual evaluations. Comparing to targets will demonstrate whether we are effectively scaling up and transforming how Tanzania monitors and responds to AMR.

Over the next 1-3 years, some key barriers FaithFlow may face and plans to overcome are:

1. Funding: Securing financing will be critical to support expansion and community engagement. FaithFlow will pursue grants from organizations supporting AMR and global health. Revenue from our data portal/apps and partnerships with stakeholders will also help achieve financial sustainability. 

2. Infrastructure: Limited lab capacity and inconsistent power/internet could hinder field operations and data sharing. FaithFlow will employ portable technologies optimized for resource-limited settings and offline/cloud data solutions. 

3. buy-in: Gaining trust and cooperation across diverse faiths may be challenging. FaithFlow's community advisory board including religious leaders will ensure activities respect cultural sensitivities and benefit communities.

4. Expertise: Building local capacity for sequencing and analysis may be difficult. FaithFlow provides extensive hands-on training and will partner experienced mentors at research institutions. 

5. Policy adoption: Guiding new policies takes time. FaithFlow will conduct robust evaluations and engage stakeholders to demonstrate our model's impact and value for informing the National Action Plan on AMR. 

With diligent planning and a solutions-oriented mindset, FaithFlow is committed to creatively addressing challenges and furthering our goal to transform AMR surveillance.

We are applying to the Trinity Challenge because it directly aligns with our vision to strengthen antimicrobial resistance (AMR) monitoring and containment efforts in Tanzania through a community-centered approach. 

Some key barriers we face that this funding opportunity can help us overcome include:

1) Limited funding - As an early-stage social enterprise, securing seed capital has been difficult. The Trinity Challenge's £1M grant would allow us to realize our 3-year scale-up plans.

2) Infrastructure challenges - Portable sequencing and cloud-based systems are needed to operate nationwide across diverse settings with intermittent connectivity and lab capacity issues. This funding ensures proper resources and supports.  

3) Expertise barriers - Building local skills for AMR surveillance, analysis and education requires extensive training. Financial support expedites hands-on capacity building initiatives.

4) Policy impact hurdles - Guiding AMR policies takes evidence. This grant empowers robust surveillance data generation critical for advising Tanzania's National Action Plan on AMR. 

5) Sustainability risks - Without long-term capital, our model's long-term sustainability is uncertain. This funding sustains FaithFlow as a demonstration project, cementing our role informing Tanzania's future resistance response.

Some potential organizations I could collaborate with to help scale my solution to the antimicrobial resistance crisis:

- World Health Organization (WHO): As the leading international health organization, WHO has extensive expertise in global health issues and the resources and convening power to support solutions operating at an international scale. Partnering with WHO could help ensure our solution is aligned with their strategies and integrated into their efforts, expanding our reach and impact. 

- Centers for Disease Control and Prevention (CDC): As the US government agency protecting public health, the CDC has deep experience tackling AMR and infectious disease threats. Partnering with them could help us test and refine our solution using their surveillance networks and technical skills, strengthening the evidence behind our approach.

- Global Antibiotic Research and Development Partnership (GARDP): GARDP is specifically focused on delivering new treatments for drug-resistant infections to those most in need. Collaborating with them would allow us to support their R&D pipelines and help ensure patients can access any outputs from our work.