MedMinders

MedMinders leverages SMS to deliver personalized medication reminders in LMICs, boosting adherence and combating antibiotic resistance through improved treatment completion.

Abasi Alfani Awazi

Problem: Low Medication Adherence Leading to Antibiotic Resistance

Global Scope: Antibiotic resistance is a major global health threat, causing an estimated 4.95 million deaths annually, with 1.27 million directly attributable to resistant bacteria. This problem is particularly exacerbated in low- and middle-income countries (LMICs) due to various factors, including limited access to healthcare, lack of awareness, and low medication adherence.

Scale in LMICs: Studies suggest that medication adherence in LMICs can be as low as  40-50>, significantly contributing to the rise of antibiotic resistance. This is a complex issue with various contributing factors, including:

• Poor communication: Patients may not understand the importance of completing the full course of antibiotics.
• Cost and access: Limited access to medications or high costs can lead to patients discontinuing treatment prematurely.
• Forgetfulness and lack of reminders: Patients may simply forget to take their medication as prescribed.

MedMinders addresses the specific problem of forgetfulness and lack of reminders by utilizing SMS technology to send personalized reminders to patients in LMICs, promoting medication adherence and ultimately contributing to the reduction of antibiotic resistance.

Serving LMIC Patients, Fighting Resistance through Simple Reminders

MedMinders targets patients in low- and middle-income communities (LMICs) prescribed antibiotics, particularly those struggling with adherence due to limited healthcare access, low literacy, or diverse cultural backgrounds.

We address these challenges by:

• Sending personalized SMS reminders: These prompts patients to take their medication at the correct time and dosage, fostering improved adherence.
• Providing brief, informative messages: These messages clarify the medication's purpose and the importance of completing the full course, enhancing patient understanding.
• Enabling two-way communication: This allows patients to raise concerns and receive support from healthcare providers, promoting better healthcare engagement.

To ensure MedMinders aligns with user needs, we will:

• Conduct focus groups and interviews with potential users in LMIC communities. This user-centered approach will provide valuable insights into their experiences, preferences, and technology usage.
• Collaborate with local healthcare providers and community organizations to raise awareness, facilitate enrollment, and ensure cultural sensitivity.
• Explore partnerships with mobile network operators in LMICs to potentially reduce SMS costs and promote broader accessibility for a wider range of patients.

By understanding the target audience and actively involving them in the development process.

MedMinders directly contributes to the public good by:

1. Improved Public Health: By promoting medication adherence, MedMinders helps: * Reduce the risk of antibiotic resistance: This benefits the global public health by minimizing the emergence and spread of resistant bacteria, which can threaten the effectiveness of antibiotics for everyone. * Contribute to curbing healthcare costs: Improved adherence can lead to reduced healthcare resource utilization and associated costs for both individuals and healthcare systems.

2. Increased Access to Effective Healthcare: The low-cost, SMS-based solution ensures accessibility to medication reminders even in resource-constrained LMIC communities with limited access to advanced technologies or healthcare infrastructure.

3. Potential for Data-Driven Public Benefit: Although not the primary focus, anonymized data insights on adherence patterns, if collected ethically and responsibly, could be used to: * Inform future public health interventions for combating antibiotic resistance. * Guide policy decisions on antibiotic stewardship and healthcare resource allocation.

Therefore, MedMinders provides a public good by contributing to improved public health, facilitating access to effective healthcare in LMICs, and offering potential for data-driven public health benefits through responsible data utilization. 

MedMinders aims to create a tangible impact by:

• Improving medication adherence: By sending timely and personalized SMS reminders, MedMinders encourages patients in LMICs to complete their full course of antibiotics as prescribed. This can:
  • Reduce the risk of developing antibiotic resistance: Incomplete courses create selective pressure for resistant bacteria to thrive.
  • Prevent unnecessary additional antibiotic use: Adherence reduces the need for repeat prescriptions due to incomplete treatment.
• Empowering patients: The two-way communication feature allows patients to raise concerns and receive support, potentially:
  • Boosting confidence and engagement in their healthcare journey.
  • Enhancing communication between patients and healthcare providers.

Evidence supporting these links:

• A 2019 systematic review found that SMS reminders significantly improved medication adherence across various chronic conditions (Vleminck et al., 2019).
• Studies have shown a correlation between improved adherence and reduced antibiotic resistance (Davies et al., 2019).

Impact on underserved communities:

MedMinders specifically targets patients in LMICs, who often face:

• Limited access to healthcare infrastructure and resources.
• Challenges with literacy or language barriers.

References:

• Vleminck, A., Van den Putte, B., De Smedt, S., & Degryse, J. M. (2019). Mobile phone text messaging (SMS) for medication adherence: A systematic review and meta-analysis. Cochrane Database of Systematic Reviews, (7), CD009770. https://pubmed.ncbi.nlm.nih.gov/26831740/

Scaling MedMinders' Impact: A One-Year and Three-Year Plan

Year 1: Building a Strong Foundation

• Pilot studies: Conduct rigorous pilot studies in LMIC communities to:
  • Refine the solution based on user feedback and adherence data.
  • Gather robust evidence on effectiveness and impact.
• Partnerships: Establish partnerships with:
  • Local healthcare providers and NGOs for wider program dissemination.
  • Mobile network operators in LMICs to explore cost-reduction strategies for broader accessibility.
• Dissemination strategy: Develop a comprehensive dissemination strategy, including:
  • Capacity building workshops for healthcare providers on implementing MedMinders.
  • Awareness campaigns targeting patients and communities in LMICs.

Years 2-3: Expanding Reach and Impact

• Scale-up: Secure funding and resources to:
  • Expand pilot programs to reach a larger number of patients in LMICs.
  • Develop a sustainable business model to ensure long-term financial viability.
• Technological advancements: Explore integrating MedMinders with existing healthcare systems for:
  • Improved data exchange and patient management.
  • Potential for AI-powered insights to optimize interventions and personalize reminders.
• Advocacy: Advocate for policy changes to:
  • Support wider adoption of SMS-based medication adherence interventions in LMICs.
  • Promote responsible antibiotic use and combat antibiotic resistance globally.

Measuring MedMinders' Success: Metrics and Evaluation Plan

MedMinders is committed to measuring its impact against its goals using the following key indicators:

• Medication adherence rate: This will be measured through:
  • Self-reported adherence data was collected through surveys or two-way communication features.
  • Pharmacy refill data 
• User engagement: This will be assessed through:
  • User enrollment rates in pilot programs.
  • Response rates to two-way communication features.
  • User satisfaction surveys to gauge user experience and feedback on the solution.
• Impact on antibiotic resistance: This will be indirectly measured through:
  • Changes in healthcare resource utilization associated with antibiotic use.
  • Monitoring discussions on antibiotic resistance awareness raised through user feedback or surveys.

Pilot Study Performance:

Once pilot studies are conducted, we will utilize the aforementioned metrics to assess MedMinders' effectiveness in:

• Improving medication adherence rates compared to the control group.
• Enhancing user engagement through enrollment rates and response rates.
• Gathering initial data on user feedback and potential impact on antibiotic resistance awareness.

Additionally, we will:

• Conduct qualitative interviews with pilot participants to gain deeper insights into their experiences and suggestions for improvement.
• Analyze anonymized data on usage patterns to identify areas for optimization.

Planned Deployment Countries (Next 3 Years):

• Current: N/A (MedMinders is in the Proof of Concept stage)
• Planned: Kenya, Nigeria, Uganda

These countries were chosen due to:

• High burden of antibiotic resistance: All three face significant challenges with antibiotic resistance.
• Mobile phone penetration: All have high mobile phone penetration rates, facilitating SMS accessibility.
• Existing partnerships: We are actively seeking partnerships with local organizations in these countries to support implementation.

Potential Barriers and Mitigation Strategies:

1. Financial Barriers:

   • Strategy: Secure funding through grants, impact investments, and potential partnerships with mobile network operators for cost reduction.
   • Resources: We will leverage existing grant applications and explore partnerships with relevant organizations.

2. Technical Barriers:

   • Strategy: Ensure technology is adaptable to different local contexts and potential integration with existing healthcare systems.
   • Resources: Partner with local technical experts and conduct user-centered design to ensure cultural appropriateness and address infrastructure limitations.

3. Policy and Regulatory Barriers:

   • Strategy: Advocate for policy changes that support SMS-based interventions and responsible antibiotic use.
   • Resources: Partner with local stakeholders and NGOs to advocate for policy changes and navigate regulatory environments.

4. Cultural Barriers:

   • Strategy: Offer reminders in multiple local languages and conduct user research to understand cultural nuances related to medication adherence.
   • Resources

MedMinders is applying to The Trinity Challenge for several compelling reasons:

1. Alignment with Challenge Focus: The Trinity Challenge's focus on antimicrobial resistance directly aligns with MedMinders' mission to combat this critical public health threat through improved medication adherence in LMICs.

2. Overcoming Barriers: The Challenge can help us address several key barriers:

• Financial Barriers: We seek grant funding to support pilot programs, user engagement, and technology development, areas where The Challenge's financial support can be immensely valuable.
• Technical Barriers: The Challenge's network and resources can connect us with technical expertise to ensure our solution is adaptable to different LMIC contexts and integrates seamlessly with existing healthcare systems, if feasible.
• Policy and Regulatory Barriers: The Challenge's platform and network can help us connect with policymakers and relevant stakeholders to advocate for policies supporting SMS-based interventions and responsible antibiotic use.

3. Access to Expertise and Visibility: The Challenge provides access to a network of experts in various relevant fields, including public health, technology, and policy. This fosters valuable mentorship and guidance as we navigate the development and implementation phases..

MedMinders seeks collaboration with several types of organizations to help initiate, accelerate, and scale our solution:

1. Local NGOs and Healthcare Providers:

• Collaboration: Partnering with local NGOs and healthcare providers would be crucial for:
  • Pilot program implementation: Their expertise and established networks would facilitate user recruitment, cultural adaptation, and local context understanding.
  • Program scaling: Collaborating with established healthcare systems can provide wider reach and ensure long-term sustainability.

2. Public Health Institutions and Policymakers:

• Collaboration: Working with these organizations would allow us to:
  • Advocate for policy changes: Gaining support for policies that encourage responsible antibiotic use and support SMS-based interventions can significantly strengthen the impact of MedMinders.
  • Access data and insights: Public health institutions might provide valuable data on antibiotic use patterns and resistance trends, informing our solution's focus and implementation strategies.

3. Mobile Network Operators (MNOs):

• Collaboration: Partnering with MNOs could enable:
  • Cost reduction: Exploring potential partnerships for discounted SMS rates would improve program affordability and increase user access in LMICs.
  • Technical expertise: MNOs can provide technical support and ensure smooth integration of SMS delivery within their networks.