1HealthIQ: the antimicrobial use dashboard

1HealthIQ will comprise of comparable data from human and animal medicinal products containing antimicrobials, extracted from point-of-sale information that are collected monthly from agrovets and pharmacies, organized by ATCC, date and location.  They will be analyzed to describe and predict antimicrobial use trends and be available on a public dashboard.  

Nduku Kilonzo, PhD, in Tropical Medicine from Liverpool School of Tropical Medicine and CEO of Afyascope Africa, an early-stage data analytics company committed to advance one health and the Principal Investigator.  

Antibiotics are a primary treatment for farm animals, are unregulated and purchased mostly from informal markets in low and lower-middle income countries (LMICs) (Robinson et.al, 2016; FAO 2021). Human antibiotics are routinely administered over-the-counter from drug stores and for mild illnesses (Tang et.al,2023). 

Despite growing antimicrobial use (AMU), there is limited data.  Available data are disparate for human and animal AMU and are largely from hospital and laboratory settings in high-income countries (Tang et.al,2023).  AMR efforts lack routine, quality and granular data to inform policy, surveillance, national and community response actions including antimicrobial stewardship (AMS) with limited generation of new local knowledge (Okolie et.al 2023, FAO et.al 2022). 

There is an urgent need to identify new data sources and generate comparable data to understand AMU in animals and humans and better target AMR efforts.  

Our solution, 1HealthIQ integrates data from two platforms that separately host: sales data on human medicine from pharmacies and animal treatment information from agriculture-veterinary shops (agrovets) in Kenya.  Products that contain antimicrobials will be isolated and quantified by type, date and geo-location and the resulting comparable data library be used to describe and analyze AMU. A free interactive dashboard will make this information public.      

1HealthIQ is intended to benefit in-country policy makers, researchers, frontline staff, market actors and general public by providing accessible and granular data on antibiotic use and access.  

• 1HealthIQ dashboard will publish trends, maps and comparative analysis of antibiotic use and access, granulated by location to benefit policy makers and national AMS inter-agency committees to facilitate decision-making.  
• The public, including civil society advocates will benefit from the dashboard from visualization, customizable reports, filtering options, podcasts/webinars and policy/technical briefs available in smartphone app and offline.
• Pharmacy and agro-vet owners/workers are first-line medicine advisors to populations and farmers in Africa.  AMS education, decision-making aids and communication material will be delivered to their devises to promote their antimicrobial stewardship efforts.  They will also have access to market and competition trends to inform their business strategy.  
• National and multi-lateral AMR surveillance networks e.g WHO AMR SQACCs, Africa CDC, as well as pharmaceuticals and researchers benefit.

We will establish a stakeholder advisory panel to provide guidance on the project and how to optimize our unique animal and human health dataset for AMR efforts.  Our formative research to inform design of the dashboard will be informed by human-centred design approaches.  

We shall provide open access to antimicrobial access and use data from 1HealthIQ up to active ingredient level.  Brand information will not be public access. Currently AM statistics and data usable for surveillance is limited to human and animal health professionals and epidemiologists. Our free-to-use interactive dashboard with routine insight briefs will increase public knowledge about appropriate AMU, food sources and risks of AMR, importance of compliance with medical advice and antibiotic use. 

The 1HealthIQ advisory panel will provide guidance on potential research questions and new areas of investigation informed by our data.  These will be published on the dashboard to give direction to researchers and help bridge the gap in existing knowledge.  Quarterly analytical policy, technical and research briefs will be uploaded to inform public health policy at global and country level. We shall publish at least two papers annually in peer-reviewed journals. 

Our detailed market analysis reports will be availed to participating agrovets and pharmacies to inform their business strategy and inventory management, including anti-microbial stocking.  A targeted AMS programme will be deployed with digital and physical educational materials disseminated to agro-dealers and pharmacy teams, and online support on treatment and AMR advise to farmers and general populations.  

Our solution will create impact for the public.  It's geo-located data provides relevance and 'realness' of AMR to communities, offering an opportunity for introspection by frontline pharmacists and agrovets.  100% participating agrovets, pharmacies will receive monthly feedback AMS support materials and strategies (CDC, 2020, https://www.cdc.gov/antibiotic...).

Policy makers and public health professionals have a rare opportunity to access granular routinely updated data from the dashboard and our quarterly briefs and reports generated from analytical insights.  

By adopting a data analysis plan guided by the advisory panel, and establishing collaborations with research institutions, including hosting masters and PhD research and modeling students, we will optimize utility of our unique data towards advancing AMR knowledge, inquiry and action. 

To deliver this impact, our primary outputs are: a functional 1HealthIQ platform capable of extracting, transforming, API integration, analyzing and reporting AMA and AMU, with integrated machine learning and predictive algorithm modules; an interactive dashboard; a multi-pronged AMS support strategy including digital aids such as webinars; educational materials; and innovative options such as seeking CPD points with country certification bodies.   

We will prioritize and fast-track enrollment of pharmacies in Kenya in order to accelerate availability data from human antimicrobial sales, as this is a foundation to building a robust comparable dataset.  

Year1: focus on data inputs and functionality of technology

• Establish an expert advisory panel to guide direction, knowledge management, data analysis and quality assurance (Lasker & Weiss, 2003). 
• Map pharmacies and non-health facility high AMU areas e.g abattoirs to enrichen geo-spatial analysis.
• Initiate data analysis on AMU in animals from AgriTrack™ 
• Undertake formative research, informed by a human-centered design in 2 countries, develop prototype and test 1HealthIQ (Rabiei et.al,2024) ensuring compliance with common data elements, data quality and architecture standards.
• Engage with in-country and global AMR and AMS inter-agency teams. 

Year2:  focus on utility of the data outputs, usability of the technology

• Continuously improve functionality of 1HealthIQ platform and dashboard. 
• Increase and publish data analysis/knowledge outputs.
• Increase dashboard traffic and disseminate emerging insights.
• Implement AMS support strategy to participating agrovets and pharmacies. 
• Strengthen stakeholder engagement.

Year3:  focus on scale

• Increase dashboard use and quality.
• Initiate enrollment of pharmacies in Uganda.
• Evaluate and improve AMS strategy.
• Increase publication of emerging knowledge, insights and research questions. 
• Scale revenue generating model.

Key performance indicators will be defined guided by the advisory panel and the Trinity Challenge team.  They will relate to the functionality, access, utility and usability of 1HealthIQ platform and dashboard; quality and size of library of comparable data; publication of sound policy, technical and research outputs; and quality of AMS support to pharmacies and agrovets. 

Year1 KPIs:

• Pharmacies enrollment rates and monthly sales data captured on AfyaTrack™.
• Functional 1HealthIQ platform: success rate in technical capabilities against planned scope.
• Quality of comparable data library.
• Functional 1HealthIQ dashboard: completion against planned scope.
• Functional advisory panel.

Year2 KPIs:

• Quality of combined human and animal data library.
• Quality and quantity of policy, practice or research generated and disseminated.
• Monthly dashboard visits.
• Coverage and satisfaction of AMS interventions with agrovets and pharmacies.
• Percentage uptime of dashboard.
• Partnerships established.

Year3 KPIs: 

• Quality and size of combined library by country.
• Number peer reviewed publications.
• Number and dashboard user satisfaction score attained.
• Quality of data outputs on dashboard.
• Participation in AMS in all countries.
• Revenue generation targets.

Regular reviews of KPIs will adjust for project progression, advisory panel feedback, external factors.  A mid-term evaluation will be undertaken. 

We are in a unique position to deliver on this challenge with our community level data on antimicrobials that covers the one health spectrum.  Some challenges may include:

Navigating data regulation laws, use of data sources that involve intellectual property can be complex and time consuming.  To address this, we will seek the necessary licensing and permissions from each country.  For instance, in Kenya, AgriTrack™ is licensed by the Data Commissioner and AfyaTrack™ application is underway. SOPs adherence will be enforced. 

It is possible that during initial phase of pharmacy recruitment, AfyaTrack™
will face resistance to data sharing.  Based on lessons from AgriTrack™, we have developed targeted communication and are reinforcing trust through consistent engagement with pharmacies and pharmacy associations in Kenya.  

To address technology challenges relating to data integration complexity, quality and consistency and scalability our scope of specifications for 1HealthIQ will be informed by formative research and guided by the advisory panel and Trinity Challenge team, throughout the development and progress monitoring phases.  

Early stakeholder engagement will be key to mitigate limited uptake/adoption and regular use of the platform by agrovets and pharmacies, civil society, AMR and AMS inter-agency teams at countries and global level. 

Building a comparable dataset of human and animal health data of sufficient magnitude in order to meaningfully inform responses to challenges across the one-health spectrum will require resources and time, which the world does not have. Our solution is a unique, innovative and much needed approach towards solving the antimicrobial use, access and resistance challenges we face.  We already have one part of the puzzle - the animal antimicrobial data and are building the second part - the human antimicrobial data.  The Trinity Challenge award will provide the necessary resources to accelerate progress towards a single data set that can provide the full picture of AMU, availability of community level data and breaking down the current silos of human and animal health response efforts.  By collaborating with governments, global and regional bodies, public health agencies, civil society, research institutions, pharmacy and agrovet owners/workers, industry and other market actors, we will make direct contributions to understanding AMU and saving lives. 

• The Trinity Challenge Team.
• AMR and AMS inter-agency teams in Kenya and Tanzania to engage and collaborate in the development of the community AMS strategies. 
• Africa CDC and the Inter-African Bureau for Animal Resources:  to understand the regional needs, benefit with guidance on how best to serve the existing gaps using our information and contribute to policy development. 
• Welcome Trust, the Bill and Melinda Gates Foundation:  As funders of AMR research and innovation, our team can benefit from access to researchers and collaborators to inform our approaches and data analysis, while also contributing to new areas of research inquiry. 
• The Global Antibiotic Research and Development Partnership (GARDP) A joint initiative by WHO and the Drugs for Neglected Diseases initiative (DNDi), GARDP to inform development of new antibiotics to address unmet needs in AMR.
• Antibiotic Resistance Coalition (ARC) and ReAct - Action on Antibiotic Resistance: to increase access to actionable community level data and information on AMR 
• World Health Organization (WHO), the World Organization for Animal Health (OIE): to benefit from understanding and by informing AMR surveillance, policy guidance, and the promotion of best practices in antibiotic use.

Since setting up AfyaScope and developing the AfyaTrack™ platform as a complement to AgriTrack™, with the vision to advance one health knowledge and action, the Directors regularly search the internet to keep abreast with developments in one health, identify and mobilize resources and explore business development opportunities.  It was on one of these searches that we came across the Trinity Challenge.