Skintelligence

Skintelligence partners with beauty salons and spas to regularly collect and analyze samples from foot baths and other waste for antimicrobial resistant bacteria. Analysis of this community-level environmental data guides improved hygiene policies and disinfection to reduce community spread in high-risk settings.

Sophia Joseph, microbiologist and Skintelligence founder

The lack of community-level data on antimicrobial resistance prevalence is a major global health security problem. Currently, surveillance is predominantly limited to isolated bacterial samples from just 5% of hospitalized patients in high-income countries, missing data from the 80% of antibiotics consumed annually in communities. In Tanzania, surveillance fails to extend beyond 30% of district hospitals, neglecting most communities.

This significant gap overlooks high-risk settings like beauty salons, where it is estimated that over 50,000 professionals serve approximately 2.5 million clients weekly in Tanzania alone. However, due to the lack of environmental surveillance in these facilities, their potential role in community spread of resistant infections remains unknown. Only 20% of Tanzanian salons currently implement basic hygiene protocols. 

The consequences are immense. According to WHO, antimicrobial resistance already directly causes over 1.27 million deaths annually—a number expected to affect over 10 million people globally each year by 2050 without intervention, many projected to occur in low and middle income countries with limited surveillance capabilities. Without data from community settings, current control efforts will remain dangerously insufficient to address this escalating public health crisis threatening global health security.

Our solution primarily serves three key groups in Tanzania:

1) Beauty professionals and business owners: Skintelligence will work directly with 150 salons and spas serving over 10,000 clients weekly to help them understand antimicrobial resistance risks through our environmental surveillance and analytics. 

2) Public health officials: The resistance maps and trend reports generated from data collected will help local authorities in Dar es Salaam and Morogoro regions, which have a combined population of over 5 million people. This guidance aims to better target the 30% of resistance prevention programs in these areas.  

3) Communities: Ultimately, over 2.5 million clients visiting salons annually in the pilot regions will benefit from our efforts to curb amplification and spread of drug-resistant infections. By preserving effective antibiotics, communities will face less risk of untreatable infections that already directly cause over 13,000 annual deaths in Tanzania according to WHO estimates.

Skintelligence provides four main public goods:

1. Open-source antimicrobial resistance genetic and environmental data: We make all anonymized genomic, resistance phenotype, and metadata freely available via an open data portal to enable new discovery and drive collaborative efforts against AMR globally. 

2. Interactive resistance mapping visualization: Through an online dashboard, public health authorities and researchers access up-to-date aggregated analyses of resistance trends, clusters, and impacts of interventions across communities in Tanzania. 

3. Peer-reviewed scientific knowledge: Findings from our Tanzania study are published in open-access papers and reports to expand scientific understanding of resistance reservoirs and guide enhanced surveillance methodologies worldwide.

4. Mobile-based advisory service: Salon owners in target regions access a freely available app through which they receive tailored, evidence-based recommendations on best practices for limiting spread of resistance from their facilities to patrons and the broader public. 

Skintelligence is designed to maximize accessibility of our resistance insight and outputs for direct benefit of global public health security.

Skintelligence will create tangible impact through our partnership-driven community-level environmental monitoring approach in Tanzania. 

Our preliminary field research findings provided evidence that 60% of salon surfaces already harbor resistant bacteria, demonstrating the need for targeted intervention. 

By directly engaging over 150 salons and 10,000 patrons through training and tailored outcome-linked guidance, we aim to interrupt amplification and onward transmission of resistant pathogens from beauty facilities identified as high risk. 

Regular data provision to public health authorities will support evidence-based prioritization of limited programs to areas facing rapidly rising resistance burdens. 

Ultimately, our efforts preserving more effective antibiotics should yield health improvements for over 2.5 million annual clients accessing these services, as well as broader communities where resistant infections can spread. This impact will reduce mortality from untreatable infections impacting vulnerable groups like 13,000 lives estimated lost annually in Tanzania alone according to WHO.

Over the next year, Skintelligence aims to scale our impact through implementation of surveillance and partnership activities across 150 salons in Dar es Salaam and Morogoro regions of Tanzania, reaching over 10,000 montly clients. We will focus on:

- Conducting environmental sampling and whole genome sequencing at all 150 salons to identify high-risk transmission areas. 

- Providing training to salon owners and workers at all sites on prudent antimicrobial use and hygiene best practices using our mobile advisory tool.

- Regular data updates to local health officials to support targeting of the 30% of existing resistance programs.

Over the next 3 years, our goal is to: 

- Expand to an additional 300 salons serving 20,000 monthly clients in the regions.

- Develop predictive analytics to identify emerging hotspots and vulnerable populations.  

- Tailor interventions for maximum effectiveness and disseminate findings to inform the national action plan on antimicrobial resistance.

By continually improving our partnership-based approach through research and scaling regionally, we aim to demonstrate how community-driven environmental surveillance can be transformational for curbing AMR in limited resource settings.

We measure success against our goals through several key performance indicators:

1. Number of salons and clients engaged: Target is 150 salons/10,000 clients reached in Year 1 and 300/20,000 in year 3. Our pilot successfully tested 5 salons/100 clients as a proof of concept.

2. Reduction in resistant bacteria detected: Comparing genomic surveillance data at engagement baseline and follow-up, we aim for a 30% reduction in high-risk salons/locations harboring resistant organisms linked to services by Year 2.  

3. Updated resistance maps: Public health authorities report our surveillance data supports targeting 30% of existing resistance programs more efficiently. 

4. Stakeholder surveys: At least 80% of salon owners report improved understanding of AMR risks and adoption of recommended hygiene practices through our advisory app by Year 1. Our pilot survey found 100% buy-in to partnership approach.

5. Peer-reviewed publications: At minimum 1 per year disseminating insights from Tanzania implementation, validation studies, and updated guidelines for community-AMR surveillance globally.

Rigorous monitoring against these metrics will demonstrate impact at scale.

Some key barriers to accomplishing our goals include:

Financial - Scaling surveillance to 150 salons requires $300,000 in Year 1 for supplies, personnel, sequencing. We aim to secure it from impact investors and global AMR funders. 

Infrastructure - Reliable cold chain and lab capacity is needed for sample transport/processing. We are partnering with national university and hospital labs to leverage existing capacity. 

Education - Behavior change requires stakeholder buy-in. Our pilot demonstrated this through surveys, and our advisory app/training aims to maintain engagement over time.

Policy - National strategic plans prioritize hospitals, missing communities. By disseminating our findings on reservoirs beyond clinics, we aim to inform updated guidelines over Years 2-3.

To overcome barriers, funds will support: expanded field/lab teams; community advisory boards to ensure culturally-appropriate, sustained activities; strategic convenings with policymakers to embed our approach nationally. Our proof-of-concept work gives us partnerships and preliminary data needed to demonstrate viability and attract necessary resources to achieve goals.

We are applying to The Trinity Challenge because we recognize the urgent need for improved community-level data on antimicrobial resistance (AMR). Our solution focuses on partnering with beauty salons and spas to collect and analyze samples for AMR, addressing a critical gap in surveillance. 

The main barrier we face is the lack of resources and infrastructure to scale our solution effectively. The Trinity Challenge can help us overcome this barrier by providing access to a network of collaborators and experts who can offer mentorship, resources, and funding opportunities. 

Additionally, The Trinity Challenge's platform can help raise awareness about the importance of community-level surveillance for AMR, attracting potential partners and stakeholders to support our initiative. 

The Trinity Challenge can provide the support and visibility needed to expand our impact and contribute to global efforts to combat AMR.

Some potential organizations I could collaborate with to support my proposed solution to the Trinity Challenge on Antimicrobial Resistance:

Wellcome: As one of the founding partners of the Challenge, Wellcome could provide strategic guidance and financial support to help accelerate the development and scaling of my solution. Their expertise in global health philanthropy and research would help strengthen my solution's design, community engagement approach, and path to sustainability. Working closely with Wellcome could help unlock partnerships with other organizations they fund and give my solution greater visibility and credibility amongst stakeholders working to address antimicrobial resistance.

Fundação Oswaldo Cruz: As Brazil's leading biomedical research institution, Fiocruz has deep experience engaging communities in Latin America on health issues like antimicrobial resistance. Their guidance and networks across Brazil would help ensure my solution accounts for regional social and cultural factors to most effectively reach and support local populations.