Holistic AMR surveillance using data & AI

To build & deploy an integrated AI-based application for strengthening AMR oversight . The amalgamation of various data points (sales channels blockchain enabled drug tracking, supply) extending to clinical, pharmacodynamic, genomic, and epidemiological information providing one integrated surveillance of AMR , data quality/collection and more precise clinical breakpoints. 

Vineet Singh Chauhan, Director

We are Addressing the inadequately regulated distribution channels  coupled with a public–private divide in healthcare which has resulted in  excessive antibiotic usage . Further , the need for holistic tool to monitor and oversee correlation that extends to data /diagnostic reporting of AMR from labs .

 Rational use of antibiotics fueled by incorrect regimens and unnecessary prescriptions, is a significant global concern. Global drug sales data highlight a notable increase in antibiotic consumption, particularly in LMICs and developing countries. However, India, encounter substantial hurdles in providing comprehensive population-based surveillance data due to challenges like inadequate lab capacity, governance issues , and limited resources. 

India and China with heightened competition between their manufacturers for crucial antibiotic ingredients, sparking various trade disputes, including anti-dumping investigations. The covid pandemic has also exacerbated the inappropriate antibiotic prescription and self-medication which has failed the attempts to combat an infection and resistance. Alarmingly, over 92% of bacterial infections, causing pneumonia, UTIs, and sepsis, were resistant to carbapenem antibiotics, classified by the WHO as watch antibiotics. The implementation of AI-based app and machine learning algorithms will provide necessary controls/real time & continuous accessibility of such dataset which can mitigate many of these shortcomings.

Our goal is to integrate and implement this data on wider scale and network to empower healthcare professionals with the tools and information they need to make informed decisions about antibiotic usage and resistance, ultimately improving patient outcomes and public health.The target audience includes various stakeholders within the healthcare ecosystem, such as manufacturers, pharmacists, clinicians, healthcare providers, and end users (beneficiaries).

To understand our audience needs, we will conduct  extensive research and engagement activities. This includes surveys, interviews, and focus to gather insights into their challenges, preferences, and requirements regarding antibiotic usage and resistance.

Throughout the development process, we will actively engage our target audience through various data sharing and communication channels. This includes regular updates and feedback sessions, where stakeholders could provide input and suggestions for improvement, & integrate this data into a centralized database, ensuring compatibility and consistency. Further, developing machine learning models capable of analyzing this data to track the flow of antibiotics through the supply chain, detect patterns of misuse or overuse, and predict potential areas of antibiotic resistance. We also involve them in user testing and validation exercises to ensure that the integration via our AI-based machine learning algorithm meet their needs and expectations.

Our solution provides valuable data for evidence-based policy-making, resource allocation, and intervention strategies to control antimicrobial resistance (AMR) at national, regional, and global levels. By leveraging technology for data integration, analytics, and collaboration, we facilitate international cooperation and knowledge sharing in combating AMR. This enables countries to learn from each other's experiences, share best practices, and coordinate efforts globally.

Furthermore, our solution promotes responsible antibiotic use by offering insights into prescribing practices, correlation, resistance patterns, and treatment outcomes. This aids healthcare providers in making informed decisions, reducing antibiotic misuse and overuse, and curbing the emergence of resistant strains. Additionally, through comprehensive AMR surveillance, our solution contributes to early detection and containment of resistant pathogens, preventing their spread and safeguarding public health. Overall, our solution supports patient safety, antibiotic stewardship, public health protection, data-driven decision-making, and global collaboration, benefiting individuals, communities, and society at large.

Considering the target audience which includes various stakeholders within the healthcare ecosystem, such as manufacturers, pharmacists, clinicians, healthcare providers, and end users (beneficiaries), who spread across both public and private healthcare sectors.

In India, there's a common observation that public hospitals, funded by government agencies, typically prescribe antibiotics at lower doses initially, reserving stronger medications for confirmed cases or severe infections. Additionally, these public hospitals often operate their own pharmacies, offering medicines at affordable rates or even distributing them free of charge, including generic alternatives to prescribed medications. On the other hand, private hospitals often charge higher consultation fees for each patient visit, leading to a tendency to prescribe stronger antibiotics upfront to address infections and symptoms.

Given this scenario, our solution aims to address the disparity between public and private healthcare sectors by integrating data from both, and creating controls/channels that through policy intervention control reckless distribution and usage. By bridging this gap, we can ensure better coordination and alignment of antibiotic prescribing practices. This entails leveraging comprehensive data analytics to guide evidence-based decision-making across both sectors. Ultimately, our solution facilitates a more standardized approach to antibiotic prescribing, optimizing treatment outcomes while minimizing the risk of antibiotic resistance development.

For initial year:

Pilot launch in 1-2 states with focus on pharma manufacturing companies  and pharmacy chains to deliver first layer of data collection. 

Further, leveraging existing network of large private labs and hospitals (200+ )  to integrate Lab & diagnostics data to deliver correlation and oversight of AMR as well

Using pilot data to engage Public Agencies & key Diagnostic chains

Expansion of Partnerships: Strengthening partnerships with government agencies, healthcare institutions, pharmaceutical companies, and international organizations will be crucial for scaling our impact.

Technology Enhancement: Continuously improving and enhancing our technology platform will be essential. 

Post one year:

Geographic Expansion: Scaling our impact geographically by expanding our solution to new regions  will be a priority. This involves adapting our technology and strategies to local contexts, engaging with local healthcare systems, and building partnerships with local stakeholders to ensure effective implementation and sustainability.

Capacity Building: Investing in capacity building initiatives to train healthcare providers, laboratory professionals, and policymakers on antimicrobial stewardship, AMR surveillance, and best practices will be critical.

Integration/API into existing public database 

By continuously assessing our progress and learning from our experiences, we can refine our strategies and interventions to maximize our effectiveness in addressing AMR.

Adoption rate 

Percentage of antibiotic prescriptions that adhere to evidence-based guidelines for appropriate antibiotic use. This includes metrics such as the proportion of prescriptions , adherence to recommended treatment durations, and avoidance of unnecessary antibiotic use. In our pilot phase, we expected to observe certain percentage increase in the proportion of prescriptions for narrow-spectrum antibiotics following the implementation of our solution and correlation of various datasets.

We monitor changes in antimicrobial resistance rates over time for key pathogens and antibiotics of concern. This includes tracking resistance patterns based on microbiological data from laboratory surveillance systems. We are anticipating a decrease in the prevalence of multidrug-resistant organisms in healthcare-associated infections within a year of implementing our solution in pilot hospitals.

We assess patient outcomes related to antibiotic use, including rates of treatment failure, complications, and adverse drug reactions. We measure how our solution improves patient outcomes and reduces the burden of antibiotic-resistant infections.

We solicit feedback from healthcare providers, laboratory professionals, and policymakers through surveys and focus groups to assess their satisfaction with our solution and its usability, relevance, and impact on their practices. High levels of stakeholder satisfaction indicate the effectiveness and acceptance of our solution in the healthcare ecosystem.

AMR healthcare data is not easily available, especially in primary care where most antibiotic prescriptions are made. This lack of data can make it harder to predict accurately. Also, Insufficient financial allocation across states, weak enforcement, and inadequate multisectoral coordination have impeded progress in addressing AMR. Also lack of private labs interaction with government surveillance.

Further, using AI tools for AMR decisions may lead to blindly following the computer's advice instead of considering a doctor's experience and intuition. Additionally, changing parts of healthcare systems to fight AMR could have unintended effects, like causing shortages of certain drugs.

Likely, there are ethical concerns about using AI to decide who gets antibiotics, as it may prioritize helping many people over individual patients' needs. Several barriers exist that may hinder our ability to accomplish our goals such as:

Lack of funding: Limited financial resources can impede growth and innovation.

Regulatory compliance: Complex or evolving regulations can pose challenges, especially in heavily regulated sectors.

Resistance to change: Cultural norms or attitudes may inhibit adoption of new ideas or practices.

Saturation or competition: Saturated markets or intense competition can limit market penetration or growth prospects.

One of the key barriers we face in addressing AMR is the fragmented nature of healthcare data, particularly the lack of interoperability between different healthcare systems and sectors. This fragmentation hinders our ability to access comprehensive and real-time data on antibiotic prescribing practices, resistance patterns, and treatment outcomes, limiting the effectiveness of our interventions.

The Trinity Challenge offers a unique platform for us to overcome the barriers we face in addressing AMR and accelerate the development and implementation of our solution Through collaboration with fellow members, including academia, industry, and government, we harness collective knowledge to develop scalable AMR solutions. Furthermore, The Trinity Challenge provides crucial funding and support, empowering us to expedite the implementation of our solution and surmount financial obstacles. Leveraging its advocacy platform, we can amplify awareness of AMR surveillance's significance and advocate for increased investment in data-driven interventions to combat this global health threat.

To advance our solution collaboration with key organizations both nationally and internationally is essential:

National Collaborations:

• a)Indian Council of Medical Research (ICMR): Partnering with ICMR grants access to research infrastructure, expertise, and funding, crucial for developing and implementing our solution.
• b)Ministry of Health and Family Welfare (MoHFW): Collaboration with MoHFW ensures alignment with national health policies and facilitates integration into existing public health initiatives targeting AMR management.
• c)National Health Systems Resource Centre (NHSRC): Collaborating with NHSRC allows us to utilize their proficiency in health system strengthening and program implementation to scale our solution across healthcare facilities in India effectively.

International Collaborations:

• a)World Health Organization (WHO): Partnering with WHO provides access to global guidelines and standards for AMR surveillance and stewardship, ensuring our solution aligns with international priorities.
• b)Centers for Disease Control and Prevention (CDC)/MHRA UK: Collaboration with CDC enables joint research projects and capacity building initiatives to strengthen AMR surveillance efforts nationally and globally.

By collaborating with these organizations, we aim to harness their expertise and resources to expedite the development, implementation, and scaling of our AMR surveillance solution, contributing significantly to global efforts in combating antimicrobial resistance.