SmartAMR: AI platform for education, adherence & tracing to reduce AMR

SmartAMR is an integrated Artificial intelligence-based digital platform for community pharmacies and veterinary services to surveillance and track antimicrobial use. Our solution mainly focused on the irrational use of antimicrobial drugs in different sectors. This data and analytics-driven solution enhances informed decision-making for reducing antimicrobial resistance.

Prof. Khondaker Abdullah -Al-Mamun

An AI scientist & digital health expert, founder of CMED Health Ltd., Director of IRIIC, UIU, and worked with GoB, WHO, UNICEF, ADB & World Bank.

The specific problem we are addressing is the widespread irrational use of antimicrobials across various sectors including healthcare, pharmacies, communities, veterinary clinics, and agro-vets in Bangladesh. Despite efforts to promote antimicrobial stewardship and awareness, practices such as self-medication, access to antibiotics without prescriptions, and unethical antibiotic prescriptions are common. An estimated while antibiotics are prescribed in nearly half (44%) of all consultations in primary health care [1]. Lack of uniformity in prescriptions and incomplete antibiotic courses further contribute to antimicrobial resistance (AMR) [2]. Besides, misconceptions about antibiotics are common among the population, exacerbating the issue [3].

Additionally, there are concerns about the use of antibiotics in animal food production, with insufficient veterinary supervision leading to the transmission of AMR through the food chain [4]. Subtherapeutic doses of antibiotics are also used in animal husbandry practices [5]. There is an 11% increase in AMR over the last five years in Bangladesh [6]. The problem extends to healthcare settings, where a significant portion of patients are affected by AMR [7], with a notable percentage displaying multiple AMRs [8]. Our solution will address all these aspects of irrational antimicrobial usage at the community level. 

Our solution targets both the community and healthcare professionals. Firstly, it aims to enhance awareness and understanding among community members and agro-farmers about the appropriate use of antimicrobials. By empowering individuals with knowledge and easy access to telemedicine services, we seek to promote responsible antimicrobial practices at the grassroots level.
Additionally, our solution introduces digital tools for drug sellers and pharmacists in medicine shops to streamline the dispensing process and ensure ethical sales of antimicrobials. Through centralized record-keeping systems, these stakeholders can track and monitor antimicrobial transactions, reducing the likelihood of over-the-counter sales without proper prescriptions.
Moreover, our solution advocates for prudent prescribing practices among healthcare professionals, including physicians and veterinarians. Finally, our solution enables policymakers and health authorities to access real-time data on antimicrobial usage at the population level. This data-driven approach empowers decision-makers to implement targeted interventions and policies to combat AMR effectively. We have conducted multiple in-depth interviews, key informant interviews, and workshops with the community people, health personnel, and policy actors while developing this solution. Thus, our comprehensive approach addresses the root causes of AMR by fostering collaboration among stakeholders and leveraging digital innovations to promote responsible antimicrobial practices.

Our healthcare model addresses global antibiotic resistance with a cost-effective approach for LMICs. Emphasizing prevention, education, and community empowerment, our platform engages community health workers, promotes responsible antibiotic use, and provides real-time surveillance data. Telemedicine services ensure accessible and affordable healthcare for both humans and animals, contributing to a healthier and informed community. Currently, as we collaborate with the Bangladesh government on the development of this solution, it aids us in implementing it within a government system, fostering greater scalability nationally and internationally.

Public Good Initiatives:

• Community Empowerment: Educating local health workers empowers communities, preventing irrational antibiotic use.
• Educational Campaigns: School programs reduce antibiotic misuse, fostering responsible habits from a young age.
• Data-Driven Engagement: Regular reports and a real-time surveillance dashboard inform and engage communities in the fight against antibiotic resistance, fostering health and transparency.
• Educating the Farmer: Providing farmers with knowledge about AMR ensures responsible antibiotic use in livestock, protecting public health. Affordable 
• Healthcare Access: Cost-effective telemedicine prioritizes widespread access, contributing to overall community well-being and public welfare.
• Data-Driven Policy Advocacy: Collaborating with authorities to shape policies ensures quality antibiotic access for the entire country.
• Open-Access Publications: Publicly sharing our solution encourages the global adoption of effective healthcare models.

With an integrated approach involving doctors, veterinarians, community pharmacies, and agro-vets, SmartAMR provides a real-time surveillance system for policymakers. Each individual's health account ensures accurate treatment, and education campaigns in schools and communities prevent antibiotic misuse. Our digital solution is crafted to enhance healthcare accessibility, affordability, and efficacy, ensuring that individuals seek antibiotics only after proper consultation. Utilizing machine learning applications assists doctors in prescribing appropriate antibiotics with precise doses. This impactful approach positively influences the community's health outcomes. We aim to assist 3 million people in the next three years and beyond. The data-driven approach provides insights into antibiotic usage patterns, informs evidence-based policy decisions, and generates community-level data. Survey findings indicate that educating people about AMR and providing accessible healthcare can significantly reduce irrational antibiotic use. This is particularly crucial in countries with limited healthcare resources, and lacking electronic patient records and public health services. These initiatives not only save lives but also improve healthcare, prevent pandemics, and contribute to greater economic prosperity.

We have piloted our AMR solution in several areas in Bangladesh with over 40 pharmacies. We are now focusing on integrating as many pharmacies and agrovets as possible. 

Next year:

• Over the next year, our goal is to deploy the extended version of our application and commence piloting in 500 pharmacies and 50 agrovets. We will educate over 1,000 local pharmacies and agrovet owners and employees through workshops and training about AMR and our application.

In the next three years:

• We will educate people about AMR using AI-based systems.      
• Complete the piloting in 5,000 local pharmacies and agrovet in Bangladesh with the collaboration of GoB and health NGOs.
• Formalize international partnerships between different countries' health regulatory bodies to operate our solutions. To accelerate this process we want to collaborate with WHO.
• We will deploy our solution in LMICs (India, Pakistan, and Sri Lanka) and collaborate with local and international organizations.

Our Research and development teams work continuously to create a comprehensive healthcare model based on Artificial Intelligence and Data Analytics.

Our objective is to integrate 5,000 pharmacies, agrovets, and veterinary clinics into our model, empowering Community Health Workers. We are focusing on tracking customer behavior, monitoring return purchases, ensuring antibiotic dose completion, and ensuring compliance with withdrawal periods in animal treatments. This strategic expansion aims to enhance healthcare accessibility and the impact of antibiotic management. We are planning to extend to other Lower-Middle-Income Countries (LMCs) for better antibiotic management, formulating effective policies addressing antibiotic use and access. We measure success by antibiotics consumption data. Through our analytics, we will analyze the data to identify behavioral changes in antibiotic consumption, aiming to prevent AMR.

We gauge the engagement and commitment of local community members using a combination of qualitative and quantitative surveys to drive ongoing improvements. Tangible indicators of success encompass changes in patients' adherence to treatment protocols, a comparison of antibiotic usage pre- and post-intervention, and a reduction in rates of antimicrobial resistance to strengthen health security measures. Regular evaluations ensure user-friendly performance with expert engagement. Direct involvement with health authorities enhances surveillance network design for better AMR care. Stakeholder meetings gather feedback on system performance, usability, and impacts on health decision-making.

We have analyzed all the gaps and challenges, and there are few issues. However, we may face some financial and operational challenges.

We have the technical experience and expertise to work on public health and antibiotic resistance, but we need funding to scale it up for the benefit of a large number of people. 
Solutions: Therefore, we are planning to seek grants and funds from healthcare organizations. 

To operate this model in the community, we first need to educate local entities such as pharmacies, drug shops, informal vendors, market sellers, traditional healers, and veterinary clinics. 
Solutions: This is a significant task that we are undertaking in phases with the help of the Government authority and NGOs.

Expanding to different countries will be challenging due to local regulations. 
Solutions: For this, we plan to seek assistance from the World Health Organization (WHO). And based on the country's regulations and culture we will customize our solution.

CMED Health Ltd., a health-tech start-up with a subscriber base of 3.5 million, has embarked on a mission to address public health issues in Bangladesh. The company has initiated an analysis of the antimicrobial resistance (AMR) problem across various regions. Leveraging operational experience in Bangladesh, we have successfully tested our early-stage solution in select areas and now plan to pilot the project on a larger scale to maximize its effectiveness.

Our focus at the community level in LMICs is geared towards reducing the irrational use of antibiotics. This strategic approach aims to combat the looming AMR pandemic. Recognizing the urgency of the situation, we are aligning our efforts with THE TRINITY CHALLENGE (TTC), an initiative that shares the same commitment. Engaging with TTC presents a valuable opportunity to intensify our efforts.

To achieve our global vision of providing healthcare services to people across LMICs, we are seeking funding and expertise from TTC member organizations that can significantly contribute to the expansion of our solution. As we navigate this global problem, the collaborative support, research, and innovation of TTC member organizations becomes instrumental in our mission to combat antimicrobial resistance on a broader scale.

Combatting the multifaceted challenge of antimicrobial resistance requires collaborative action across various sectors. This includes targeted initiatives within public healthcare in LMICs, alongside research efforts, focused on reducing and monitoring this growing threat. Through such integrated strategies, we want to make sustainable solutions.

WHO: AMR impacts countries globally, with the greatest impact on LMICs due to poverty and inequality. WHO is actively addressing this by developing One Health action plans in nations. For scaling our solution we aim to collaborate with WHO for their support in additional funding, research, and development.
Johns Hopkins Bloomberg School of Public Health:  They tackle global health challenges like infectious diseases and maternal health through research and partnerships. Their HI-CARB center harmonizes with our goals, making them a strong collaborator for developing solutions.
Bill & Melinda Gates Foundation: A champion for global health equity, this organization funds research and development to fight infectious diseases. We believe their focus on collaboration aligns with our fight against AMR, making them a valuable partner.
Harvard T.H. Chan School of Public Health: We believe they are an ideal partner in the AMR fight. Their expertise in research, education, and practice, aligns perfectly with our goals of developing and implementing effective solutions.