One Health AMR Data Integration and Sharing Information System (DISIS)

The One Health AMR Data Integration and Sharing Information System (DISIS) is a web-based platform that pools data on antimicrobial resistance, consumption and use surveillance from the human health, animal health and environmental sectors in Uganda. This ensures findable, accessible, interoperable and re-usable (FAIR) data by stakeholders. 

Dr. Francis Kakooza 

AMR is a leading cause of morbidity and mortality globally. In 2019, approximately 1.27 million deaths were attributable to AMR, with 1.05 million of these deaths occurring in low- and middle-income countries (LMICs). In Uganda, the age standardized mortality rate due to AMR is approximately 125–150 per 100,000 population. Inappropriate use of antibiotics is the main driver of AMR. While response against AMR is dependent on the ability to measure and monitor both the burden of AMR, use and consumption of antibiotics, community-level data on these metrics is lacking in LMICs, including Uganda. Available data is from tertiary hospitals, despite almost 90% of the population receiving care from community-based primary care facilities. Additionally, antibiotic use on farms and sales in the community veterinary drug shops is not monitored. Our proposal aims to extend the capacity of an existing platform (DISIS) to collect data on antibiotic use from the community level (households and farms), advance its data analytics capabilities, and support its integration with national-level data (AMR data from hospitals and antimicrobial consumption surveillance data from national warehouses and hospitals). Collecting community-level data will enable us to understand antibiotic use pathways and drivers of AMR in the community. 

The DISIS was conceptualized through co-creation, working with key stakeholders who provided input on how data would be collected, stored, and shared. A need assessment was conducted, and consensus was built for its development among key stakeholders, including academic institutions and government ministries, through the National One Health Platform.

At the national level, the solution will improve access to integrated one health data from nationally representative data sources. We will upgrade the system to share data on antibiotic use trends and geospatial use maps so that national response is targeted. Academic institutions and researchers will be supported to use the data to advance the research agenda. The DISIS platform already supports AMR stewardship at national level by contributing to the WHO Global Antimicrobial Resistance Surveillance System (GLASS) system annual reporting. We aim to keep DISIS “FAIR” by sharing the collected data with other regional and global institutions including Africa CDC, WHO and FAO to advance the global AMR control agenda. At the community level, we shall engage Village Health Teams (VHTs), veterinary assistants and famers to collect data on antibiotic use. We shall share quarterly dashboards synthesizing the data to inform rational use of antibiotics in the communities.

The DISIS will make data available to stakeholders including, policy makers and researchers, both locally and internationally for research and AMR governance. Synthesized data will be used to generate free access information for the public to inform appropriate antibiotic use and action to combat AMR. DISIS will support education and research support by making the data open access and usable by education and academic institutions. The IDI is Makerere University affiliated academic institute. IDI will promote use of DISIS data for learning and use by university graduate students and researchers. This will in turn contribute to advancing the global research agenda on AMR. The development of web applications to support data collection at the community level will foster innovation for data scientists and developers in the country, with priority given to young scientists from the College of Computing at Makerere University. Regional and global collaboration will be fostered, and the global AMR containment agenda advanced through making FAIR data available for action by policy makers, researchers, and development. The project has potential to contribute to optimization of antibiotic use, contributing to containment of AMR, leading to healthier communities. Open-source peer-reviewed publication will be undertaken throughout the project

For patients and farmers, the solution will lead to healthier communities through contributing to optimization of antibiotic use. Additionally, through linking household health data to antibiotic use data, national AMR data and national AMCU consumption data, the ministry of health will take appropriate actions to protect public health. For farmers, the ability to track antibiotics used and receive appropriate information on how to use antibiotics following data analysis will have household incomes and livelihood, through saving money from unnecessary use. For the national one health platform, the data generated and shared through the DISIS will inform future development of a data-driven evidence-based national AMR program. For students and researchers, the data available through the DISIS provides an opportunity to conduct research on AMR, advance careers and contribute to global learning. For the global community, the solution provides FAIR data to support global efforts to contain the public health threat of AMR.

Capacity strengthening approaches that focus on individual and institutional capacity will be implemented throughout the project cycle. These will include targeted trainings, workshops, boot camps for enhancing skills. A team of computer scientists, data scientists, implementation research scientist will be trained and recruited at the institution to support implementation and use of the data for decision making. The project will engage stakeholders including the communities (farmers, patients, village health teams, agricultural extension workers) throughout the project life cycle. Through these initiatives the solution products will be shared, opportunities for product scale up explored and input obtained for improvement. Working with Makerere University, the scientific community and policy makers will be engaged early in the project, to ensure uptake of the solution. Further, we shall participate in Open Science publication to ensure availability of project outputs to the scientific community. Technology transfer to the One Health platform and other global stakeholders e.g. Africa CDC, WHO, regional governments, that may be interested in uptake of the solution. Establish partnerships and collaborations with government, civil society organizations and other future funders for the project to ensure sustainability, support uptake and expansion to other countries. Explore further infrastructure development to improve the solution.

The proposed project outputs include creating a community-level data collection module into DHIS-2, integrating it into with DISIS and building capabilities of DISIS for data analytics including modelling. We will also measure the number of VHTs and vet assistants collecting data on community AMR. We aim to collect data from 10 districts in year 1, 15 districts in year 2 and 20 districts in year 3. We will track the number of users (patients, farmers, village health teams and agricultural extension workers) and their retention in the system. We aim to enrol 40% of all VHTs to collect AMR data by year 1 and this will raise to 80% by year 3. To measure short-term impact. We will track and measure temporal reduction in antibiotic use at community and national level. We will measure antibiotics use at household and farm level. The number of reports from the community will be reported quarterly. We aim to publish 10 manuscripts from this project. The use of data for decision making, number of policies arising from the project, adaption and roll-out of the project to more communities and other countries will be other measures of success for the project.

Some geographical areas have limited internet and mobile phone coverage. We will build the DHIS-2 app with capability for data collection and backup when offline. Technology barriers to developing web applications for data collection from households and farms and for enhancing capabilities of the DISIS to harvest data from the servers of the linked one health sectors. We shall work with computer scientists and developers to develop the apps and advance capacity of the DISIS to harvest and integrate data. Human resource barriers, twill be overcome by enrolment of VHTs and agricultural extension workers in collaboration with local governments. The VHT system has largely been successful, and we anticipate good acceptability of our innovation. The VHTs and agricultural extension workers will be supported with internet access. Decisions, and policies in Uganda (and other LMICs) policies are often not guided by evidence and data. We will engage policymakers to leverage data but aware of this potential risk. The recently enacted Uganda Personal Data Protection and Privacy Act 2019 Uganda Personal Data Protection and Privacy Act 2019 restricts data sharing out of the country and this may hinder international collaborations and data sharing.

The goal of the solution is to optimize antimicrobial use and contribute to the control of antimicrobial resistance. The country’s JEE capacity on AMR has not fully matured, partly due to gaps in AMR related data, especially at the community level, i.e., patients, farmers, and the communities from which they come. We aim to bridge this gap by developing relevant applications, that are easy to use and driven by the communities them-selves, support communities collect and share data to the national platform, support systems for integration and use of the data for informed decision making and make information from the generated data available to communities for use for impact. We shall build national and regional capacity for making FAIR data available for use to inform decision making. Specifically, we want to bridge the gap between communities and national level action on AMR, using a one health approach. Through this, we shall make available public goods to the community including data, information, policy briefs, open access peer-reviewed publications and promoting education and training. We aim to show-case how LMICs can set up national systems for FAIR data towards AMR containment, make technological innovations access for scalability and use in other countries. 

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