Automated, near-real-time AMR community surveillance, using effluent

Untap Health have multi-patent-pending hardware for automated detection of bacterial RNA / DNA within a community’s effluent (including sewage). This technology is plug-and-play, provides data in under three hours, and installed by a person with minimal training. This creates new opportunity to passively provide continuous updates, including locally.

Dr Claire Trant FRSA, CEO and Founder.

Monitoring community level data for antimicrobial resistance is a challenge; it usually requires active sampling of individuals and testing in a laboratory setting. This is expensive, time consuming, slow and can lead to community mistrust. The current costs are estimated to reach trillions of dollars in years to come, and the annual deaths is estimated in the millions. 

Sampling effluent and sewage is an effective means of passively sampling the community’s health, providing a representative sample of the population. However, current technology for sampling waterways requires samples to be collected manually, transported to a laboratory and analysed. This remains slow, especially in LMICs where access to a laboratory may be limited, and often too expensive.  

Untap Health are solving the problem of collecting effluent and sewage, analysing this sample and removing the need to access laboratories. Untap Health are solving the problem of access to community-level data in LMICs. 

Untap Health has developed this technology to be low cost, small and able to be installed rapidly. We have also developed this technology to detect up to 12 RNA/DNA biomarkers in a single unit. These design choices were intentional, so as to be able to deploy this technology where it is most needed. We have been working with communities that require this technology the most, the most vulnerable in society. Thus far, we have predominantly worked with care homes detecting norovirus. However, due to the platform nature of this technology detecting a range of bacterial and viral RNA / DNA this technology can serve a more broad audience, including detecting for antimicrobial resistance bacterial RNA.  

As we develop the solution we have been piloting our technology on customer sites. We have a test bed site at a care home in Ascot. This has enabled us to develop our multi-patent-hardware and proprietary dashboard to better cater for their needs. 

Untap Health have developed a platform technology to detect viral bacterial RNA and DNA at low cost. This will allow this technology to become widespread across almost any geography. With this technology being deployed widespread we will be able to detect local areas of antimicrobial resistance at a lower cost and more frequently than ever before. This will enable it to be combatted much sooner than previously possible. Untap Health being deployed to detect for viral biomarkers will also enable to early detection and therefore the early instigation of measures to reduce the transmission. We believe that our technology will therefore have an impact on the infectious diseases of tomorrow. 

We envisage a world where Untap Health being commonplace will allow people to alter their behaviour accordingly: 

• When the chance of rain is high, you take out an umbrella. 
• When the chance of infection is high, you put on a mask or work from home. 

Access to this data will empower the public to manage their own risk. 

Currently, there are few solutions for the early, low cost detection of antimicrobial resistance in communities. Especially in low and middle incomes countries. Our technology provides a truly scalable solution for the widespread early detection of antimicrobial resistance, and therefore will have an impact on policy and decision making processes. This will enable decision to be made early. This will reduce the both the financial cost of antimicrobial resistance and the cost of life. 

Our target populations are the those that are most vulnerable. Our technology being installed to detect for viruses in locations such as care homes, detects illnesses sooner, enables 'micro-actions', such as touch point cleaning, to be initiated earlier, to prevent the spread of disease. this will ultimately prevent death. In the pilot we carried out with a care home, we were told of a recent norovirus outbreak killing nine residents.

Untap Health currently have a prototype that we are piloting at customer sites. In 2024, we are testing this prototype at multiple customer sites, iterating and stress testing this prototype so that it is able to succeed in a range of environments.

In the next six to nine months this will be developed into a product that can be manufactured at scale. We plan to initially manufacture up to 20 units and deploy these in 2025. These will be deployed close to our headquarters in South London at a variety of sites, with differing numbers of people, and with other variables. the need for proximity to our HQ, is such that we can rapidly test, fix and iterate this initial product.

In 2026 we plan to manufacture this technology at a scale of 100s so that it can be exported. We understand that there will be novel environments when the technology is exported, for example more extreme temperatures.

In 2027 we therefore aim to deliver a product that is available to global geographies, and therefore to provide a global impact.

Untap Health monitors impact every time we detect viral or bacterial RNA or DNA. As each time we register an increase at a pilot site of a biomarker we are detecting, we alert the customer. This then enables the customer to take action to reduce the impact of that on their community. This is information that the customer would not otherwise receive until someone within their community started showing symptoms, and either was removed from the commuity (isolated or leave), or taken for medical aid.

We currently bench mark our data that we generate to third party laboratories to assure us that we are providing reliable and robust data. 

A direct example of the impact our technology can provide: In January 2021, the factory (R & M Electrical Group) was lateral flow testing their entire workforce daily as they were suffering with whole production delays due to COVID-19. Untap Health was able to build a positive correlation between their lateral flow data and our wastewater data. However, we also detected COVID-19 when they did not, we found that they had external visitors (their auditors) on site that were not being tested daily.

Barriers to this technology being widespread is largely societal mistrust about information gathering about public health. Untap Health have already received push back from communities about our technology being installed in their infrastructure. We have received comments including that we are 'big brother' surveillance. With this in mind, we have decided that we will not monitor communities under 50 people, so as to never become a diagnostic device. We will remain a community level warning technology. We have also decided to not test for illegal drugs and human habit biomarkers, including alcohol, tobacco, cannabis and cocaine. We believe this would lead to the public mistrust in our technology, and our brand. This is something we plan to publish publicly on our website so as to build that brand trust.

Health surveillance using effluent and sewage is not a publicly known technology, and therefore a lot more customer education is required to penetrate the market. This is something we are building in-house capability for, as we scale.

Untap Health has the internal company mission to impact as many people as possible, especially those most vulnerable. The Trinity Challenge would enable us to develop our technology to also detect for antimicrobial resistance and also to work alongside people who can help us deploy our technology in the places that need it most. We are currently limited in our ability to expand into antimicrobial resistance due to our limited network within this field. We are also a capital-intensive company, as is the nature of hardware. This grant would hugely alleviate this worry and enable this technology to have a massive impact. The real benefit is both in the capital from this grant but also largely in the partnerships it provides.

The Gates Foundation is one of the largest philanthropic organisations globally that impact so many people in need. Working with them would provide us with a plethora of incredibly beneficial resources such as guidance and expertise in leveraging our health data to provide benefit for public health. As well as to help us refine Untap Health’s solution's strategy and execution with their extensive networks and partnerships with governments, NGOs, and health companies.

Access to the Institute for Health Metrics (IHME) large repository of health data and insights could help us refine and validate our solution, as a company that aims to benefit others with our health data. Additionally, collaboration with IHME can help accelerate the adoption of Untap Health’s solution, helping to influence healthcare policies and interventions globally.

Working with Dr. Evidence could help us improving the effectiveness  and reliability of Untap Health’s solution, enabling us to scale and accelerate deployment of our technology into areas that need it most such as low income countries.

These three organisations share our values to better public health and reduce the impact of diseases on the vulnerable, not to mention that they would also validate our credibility as a company.