AIccompany

Rain fell. Water levels rose. On a summer day, freeways became rivers, and my Mom was in a rush. She forgot to pack her medicine. The climate disaster forced her to flee.

What would you pack a bag if you were facing a hurricane, an earthquake, or a conflict? During wildfires in California, one family member per household left prescription medication behind.

Impact Opportunity: 

89.3 million people worldwide have been forcibly displaced.                       60 million refugees have been forced to leave their country (UNHCR data). 

Humanitarian aid focuses on the immediate aftermath. Host nations screen refugees for infectious diseases. But complex chronic diseases, such as cancer, are neglected.

52% of Syrian refugee “cancer patients with poor prognoses are turned away because caring for them is too expensive”(Dr. Spiegel's comment on the UNHCR Exceptional Care Committee; full-article reference Spiegel et al. 2014 Lancet Oncology). 

There will be an estimated 20 million new cancer cases and 10 million cancer deaths worldwide in 2023 (Globocan data). The global burden of cancer will increase to 30 million new cases (among nationals and refugees) by 2040, with an increasing burden occurring in low- to middle-income countries (LMICs). Forced displacement can disrupt a cancer patient’s continuity of care (stability, security, access to medical facilities, or clean water), and climate-driven environmental exposures may increase cancer risk (Op-Ed titled "The Varieties of Climate-Driven Medical Risk" by Aditi Hazra published in Project Syndicate) among displaced individuals. 

Customer Discovery:

In Ukraine, cancer patients were seeking treatment while fleeing bombs, and bullets, facing medical facility destruction, food insecurity, water insecurity, and a severe winter without reliable power. Refugee cancer patients in a new host nation may not have affordable access to cancer diagnostics and care. An approximate 30% dropout rate is estimated in clinical trial design. Displacement can lead to increased dropout rates from clinical trials. Approximately 20% of cancer clinical trials fail because of inadequate patient recruitment and retention. Terminating trials due to conflict or climate crisis may increase global health disparities and delay therapeutic discoveries. Generative AI can combine sources of data to bring analytics and prediction of patient needs in fragile contexts to the next level with multimodal capabilities. 

Feasibility: Over one-hundred cancer clinical trial patients received care in neighboring countries in the initial days after Russia invaded Ukraine. On February 24, 2022, the regulatory rules were unclear. Trial sponsors and researchers united across borders to identify regulatory solutions and provide medicines to refugees. Refugees continued their care without missing a single cycle of cancer treatment. However, language translation remains a barrier. 

We are solving the problem of health in fragile contexts. Our solution, AIccompany, addresses the continuity of cancer care in fragile contexts. 

Inclusive Human Centred Approach: AIccompany catalyzes multimodal communication, connection, and continuity of care by connecting technological innovations. AIccompany delivers multimodal assistance to increase personalization, enhance patient navigation, and empower clinical teams. Our solution technology recognizes and translates prescription label instructions and warnings. The AIccompany prototype prioritizes recognition and translation to languages commonly spoken by refugees in 2023.

A 30% dropout rate is estimated in clinical trial design. Displacement and fragile settings can increase patient dropout from cancer clinical trials. The Team Lead (Aditi Hazra) published a bold Letter on bringing cancer clinical "trials to the (refugee) patient" in Science on May 12, 2023. The impact of the solution is to facilitate care continuity for refugee and displaced patients anywhere.

Technical Feasibility:

AIccompany has developed a prototype of the integrated optical character recognition (OCR) technology and translation model.  For example, the prototype backend can accept the medication package insert for Pfizer's Ibrance (palbociclib) capsules as input and output translated text on medication storage, dosage, and use. Next, we will simulate a clinical trial (randomized/customized) prescription label and package insert to train the model. AIccompany's translated text and generative AI will offer multimodal assistance to enhance the patient experience.

Partnerships for Health in Fragile Contexts:

UCRSI (Ukraine Clinical Research Support Initiative)

UACR (Ukraine Association for Clinical Research)

Currently, universal access to essential cancer diagnostics and medicines is not available for refugees. Our patient-centric solution serves refugees and displaced persons enrolled in cancer clinical trials. The clinical trial framework will allow AIccompany to train on the customized experimental or standard of care medication labels and instructions. Generative AI technology (GPT) will allow real-time collection of data on adverse effects. The solution will be trained to identify patient comments that require attention, such as escalating an SMS alert to the clinical trial physician and documenting the patient's side-effect in real-time.  Data collected on medication adherence can inform cancer drug and overall medication procurement needs in humanitarian settings. The data can alert trial sponsors to inadequate buffer stocks and social service needs (clean water, food, shelter) for the displaced patient and their families. Importantly, the Generative AI solution will generate potential options for urgent care for the decentralized clinical trial patient navigator and on-call clinician to discuss with the patient. The solution will reduce caregiver burden and burden-share with healthcare providers in the host nation.

The long-term impact of the solution is to catalyze the establishment of a standardized set of guidelines to improve cancer care and outcomes in humanitarian settings. The solution is developed for cancer clinical trials but can also be scaled to clinical trials for other disease outcomes.

Stakeholders:

Clinical trial sponsors

Clinical trial clinical research organizations (CROs)

Union for International Cancer Control (UICC)

Multilateral Development Banks

United Nations High Commissioner for Refugees  (UNHCR)

UN International Organization for Migration (UN IOM)

World Health Organization (WHO)

Strategy to Scale:

AIccompany may help improve patient diversity and inclusion in clinical trials in both fragile and stable settings. 

Once trained and optimized, AIccompany may add value outside of the clinical trial framework. The US Title VI of the Civil Rights Act of 1964 requires healthcare providers and recipients of federal financial assistance, including pharmacies, to provide meaningful access for LEP (limited English proficiency) individuals. This includes prescription translation services. 

In Oregon, the Oregon Law ORS 689.564 went into effect on January 1, 2021, requiring pharmacies to provide translation services in 14 languages as requested by an LEP patient.  However, translation services are not available nationwide. AIccompany is scalable to serve diverse communities in the US. Stakeholders, including pharmacies serving LEP patients and Federally Qualified Health Centers (FQHC) may benefit from AIccompany services. FQHCs serve 30 million patients. Approximately 1 in 5 FQHC patients are uninsured. Language and translation needs have been identified as a barrier to cancer prevention care delivery at FQHC. AIccompany is poised to scale and help FQHCs address cancer prevention and control disparities.

In May 2017, Aditi Hazra (Team Lead) met with the eighth Secretary General of the United Nations H.E. Ban Ki-moon to discuss global breast cancer. The former Secretary General Ban Ki-moon asked Dr. Hazra to research the health of Syrian refugees. She organized the “Global Refugee Health” symposium on World Refugee Day at the Harvard Chan School of Public Health. She advocated for the radical inclusion of refugees in the multistakeholder initiative to accelerate cervical cancer eradication at the UNGA Side Events (2018).  Although her plans and support to travel to Zatari in Jordan were disrupted by the COVID-19 pandemic, she had developed grant proposals with input from collaborators at the King Hussein Cancer Center in Amman, Jordan, and Syrian women refugees.  She analyzed quantitative data on disparities in breast cancer characteristics among Syrian refugees compared to Jordanian women and wrote the scientific manuscript (under review). She authored Op-Eds on including refugees in COVID-19 care (published in Project Syndicate in 2020) and was interviewed by South Korean Global News (Arirang TV News). She also wrote an Op-Ed on chronic disease risk among displaced persons and climate refugees (published in Project Syndicate in 2022). 

Since the Russian invasion of Ukraine on February 24, 2022, 8.2 million refugees (UNHCR data, April 2023) have been forced to flee to neighboring countries, including Poland, Moldova, and Romania. The refugees are mostly children, women, and older men. Almost "one child per second becomes a refugee" in Ukraine (Personal communication, Pierre Toutain-Dorbec and Aditi Hazra). Dr. Hazra, is a member of the Ukraine Clinical Research Support Initiative (UCRSI) and European Cancer Organization (ECO)-American Society for Clinical Oncology (ASCO) Special Network for Ukraine. She has collaborated with the President of the Ukraine Association for Clinical Research to develop a survey on clinical trial needs in Ukraine in 2022 to better understand the needs of the refugee community she is serving. She currently collaborates with Professor Igor Bondarenko, MD, in Dnipro, Ukraine. Professor Bondarenko is an oncologist and is the principal investigator of a leading oncology clinical trial site in Ukraine. Dr.  Hazra and Dr. Bondarenko authored the high-impact Letter titled "Clinical trials can adapt for refugees" to be published in Science  (online journal publication date May 12, 2023). 

Dr. Hazra is a leader and innovator in cancer research with a record of scholarship (>60 publications), grant funding, and patient engagement. She attended the 2023 Decentralized Clinical Trials meeting in Boston and spoke with expert stakeholders, clinical trial sponsors, and CROs about the problem. 

We have developed a web framework API prototype to recognize text on images of prescription labels and provide language translation. 

We have initiated the development of engineering prompts for an AI-powered TrIal Assistant (TIA-bot).

AIccompany is at the prototype stage. Our next step is to train and iterate on the solution. At this pre-revenue stage, our solution is not available to serve yet.

Solve can help us connect to technical experts and help us overcome financial and legal barriers. 

AIccompany drives value by improving the patient experience, reducing long-term costs for clinical trial sponsors (and insurance companies), and improving patient survival. 

Cancer patients in fragile settings face barriers in access to diagnostics, cancer care (and other chronic disease care) and may have limited access to electricity and WiFi. To address the ongoing disparities and UN Sustainable development goal (SDG) Target 3.4 to “reduce by one third premature mortality from non-communicable diseases” we empower care and resilience in an improved way. The name "AIcommpany" is a tribute to Dr. Paul Farmer's model of "accompaniment". To accompany someone is to go somewhere with him or her, to be present on a journey. 

A 2017 study should 93% of all refugees live in areas with 2G network coverage, 62% of all refugees live in locations with 3G network coverage and have mobile phones. AIcompany will go with refugees on their clinical trial journey. First, patients will not feel alone in the fragile setting. 

Second, AIccompany will de-risk conducting decentralized clinical trials in fragile regions. For example, patients enrolled in a phase II or III clinical trial with an oral therapeutic can use SMS messaging to report adverse events. The Generative AI (GPT) feature will alert the clinical trial navigator and clinician and record the adverse event in real-time. AIccompany will help connect displaced patients to the decentralized trial network for urgent care needs in the fragile context. We will use geolocation and navigation app partner (SIRCA) to identify the nearest health care facilities and social services accessible during a crisis where all roads may not be accessible. 

Third, AIccompany is agile and incorporates standards (for documenting patient side-effects) with customization. Our solution has interoperability and is complementary to more expensive, labor-intensive platforms and services that can only be leveraged in settings with secure high-broadband WiFi, and electricity.

Our SMARTIE (specific, measurable, attainable, relevant, time bound, inclusive, and equitable) goals for the next year are to reduce the dropout rate for an international, phase II or phase III cancer clinical trial. Over 100 Ukrainian refugees received care in neighboring countries in the early months of the Russian war. However, enrollment was paused for other clinical trials. AIccompany multimodal assistance to increase personalization, enhance patient navigation, and empower clinical trial teams. Cancer care continuity will have a transformative impact on patient's lives. 

Our goals for the next five years are to contribute to strengthened policy, financing advocacy, and patient support for cancer care in fragile settings and humanitarian crises. Refugees in protracted displacement settings may elect to opt-in and join virtual support groups (using Zoom and translated closed captioning piloted by Dr. Hazra for STARS Exercise) to connect with other cancer patients and patient advocates in the host nation. AIccompany will advocate for sponsors to include refugees in host nations with existing clinical trial infrastructure (e.g. Germany, South Africa, Canada, US, Mexico, Brazil) and encourage sponsors and CROs to build decentralized clinical trial infrastructure in LMICs and rural US.

Our solution aligns with UN Sustainable development goal (SDG) Target 3.4 to “reduce by one third premature mortality from non-communicable diseases” and Target 3.8 on universal health coverage and SDGs 1, 5, 10, and 17.

Our key metrics are the number of patient users and patient encounters. We will record the number of total patients enrolled at a trial site in a fragile context and the number of displaced patients during the trial period. A second metric is the dropout rate at trial sites in fragile settings with AIccompany compared to a trial site in a similar fragile setting without AIccompany.

Address root causes of disparities in access and inclusion in cancer clinical trials and eliminate barriers

Co-create culturally appropriate communications (language translation, customized SMS scripts, TrIal Assistant prompts, GPT prompt engineering)

Provide social support and clinical connectivity 

AIccompany's AI-powered solution incorporates OCR, translation models, SMS, geolocation, and GPT technology.

AIccompany was developed by the Aditi Hazra, Founder of PinkSari, a charity for Global Breast Cancer Prevention.

The solution may employ a non-profit or hybrid model.

Aditi Hazra champions “leave no one behind” and inclusive innovation as the Founder of PinkSari, a charity for global breast cancer prevention. She was trained as an EMT and volunteered in the aftermath of hurricanes and floods to help displaced individuals and health clinics for vulnerable populations (H.O.M.E.S. Clinic in Houston, Texas). Dr. Hazra has an exceptional record of advancing diversity, equity, and inclusion in her research aims, teaching and mentoring, and humanitarian work. She has contributed to patient engagement with civilians, Veterans, refugees, and undocumented individuals. She believes in co-creating environments where all members are encouraged, respected, and valued.

AIccompany will provide multimodal assistance and generate social value and economic value for sponsors across their value chain. AIccompany will offer customized communication for patients, speed and efficiency for real-time alerts and documentation of adverse effects, and analysis and prediction for sponsors.

AIccompany was created to enable continuity of care and will be free to the displaced patient. Our primary revenue source is clinical trial sponsors. AIccompany will employ a subscription model-based revenue stream for clinical trial sponsors based on the trial period in months and the number of participants. 

Additional revenue streams will include multilateral organizations such as WHO, UNHCR, and UN IOM. Our solution will be complimentary and interoperable with available decentralized clinical trial platforms. We will explore partnerships with organizations such as International Rescue Committee. We will apply for Union for International Cancer Control (UICC) grants and explore service contracts with the US State Department Bureau of Population, Refugees, and Migrants.

We are actively seeking donations, grants, and partnerships. Aditi Hazra personally supported prototype development for the SOVER challenge. We are planning an auction in hopes of generating funding for server storage fees and continued AIccompany technology development as well as access to medicines for refugees.