RxVision

RxVision is a decentralized platform using smartphone microscopy, AI and microfluidics to empower community clinics in LMICs with rapid antibiotic susceptibility testing. By providing actionable resistance insights within hours, it improves treatment selection and enables same-day monitoring of changing resistance patterns to optimize patient care and public health.

The Team Lead for RxVision is Zena Mmary, Infectious Disease Clinician and Head of Microbiology Services at KCMC Medical Clinic in Moshi, Tanzania.

In Tanzania, antimicrobial resistance poses a major threat to public health. According to the Tanzania Healthcare Quality Situation Analysis Report 2019, nosocomial infections affect 10% of hospitalized patients, 80% of which are drug-resistant. A 2017 study at Kilimanjaro Christian Medical Center in Moshi found over 50% of staphylococcal isolates were methicillin-resistant. 

Across sub-Saharan Africa, inadequate surveillance means the scale of resistance is underestimated. A WHO report estimates that by 2050, drug-resistant diseases could claim over 10 million lives globally annually and push nearly 25 million people into extreme poverty. Currently, at least 700,000 lives are lost each year due to drug-resistant tuberculosis, HIV, and malaria.

One of the major causes driving this growing crisis is limited access to rapid diagnostic tests in local healthcare settings where antibiotics are most widely used and misused. Conventional phenotypic antibiotic susceptibility testing requires specialized equipment and skills typically only available in well-funded regional and national reference laboratories. Results often take 5-7 days, hindering timely optimization of treatment. 

RxVision directly addresses this problem by providing community clinics in Tanzania with an affordable, easy-to-use platform for same-day antibiotic susceptibility profiling using smartphone-enabled digital microscopy and AI. 

RxVision primarily serves frontline healthcare workers and public health professionals managing infectious diseases at rural primary healthcare facilities across Tanzania. 

Through visits to 20 pilot clinics in the Kilimanjaro region, we have conducted needs assessment surveys with 50 clinicians and microbiologists. This provided key insights into their context - limited diagnostic capabilities, lack of rapid testing, difficulties promptly optimizing treatments, and inability to securely share patient data or resistance trends with specialists.

Our solution addresses these needs by empowering clinics with same-day antibiotic susceptibility testing using smartphones, providing a platform to facilitate remote expert consultation and decision support through encrypted clinical data-sharing, and enabling real-time monitoring of resistance in underserved communities to better inform public health interventions.

We have ongoing engagement with Ministry of Health officials and networks like the Kilimanjaro Clinical Officers Association to collate regional AMR priorities. End-users have access to an online help desk and are involved in weekly product development workshops.

By the end of 2027, we aim to rollout RxVision to over 1,300 primary healthcare facilities across Tanzania in order to serve more remote frontline clinicians managing infectious diseases at their communities.

RxVision directly provides the following public goods:

1. Open-source antimicrobial resistance data: Our de-identified testing results and epidemiological findings are published on an online open-data portal to support research by other public health organizations, academics and policymakers working to address AMR. 

2. Community-level health insights: Regular situation reports analyzing surveillance trends, risk factors and optimized treatment strategies are shared freely with regional authorities and the Tanzanian Ministry of Health to guide resource allocation and strategy development.

3. Ongoing training and education: We conduct training workshops and online courses to disseminate best practices in diagnostic stewardship, infection control and data-driven decision making. This strengthens capacity among frontline health workers and microbiology networks.

4. Cloud-based clinical decision tool: RxVision's integrated diagnostic-prescribing platform will be made available for free use by approved public sector facilities. Its treatment recommendation algorithms aims to optimize antibiotic use across Tanzania's public health system.

By prioritizing open data access, capacity building initiatives and cost-effective solutions, we seek to maximize the public health benefits arising from RxVision's innovative approach to tackling antimicrobial resistance.

RxVision aims to directly benefit underserved rural communities in Tanzania facing high infectious disease burdens but limited diagnostic access. 

By the end of 2027, our solution aims to decentralize rapid antibiotic susceptibility testing to approximately 1,300 local primary care clinics using our microfluidics and AI platform. This represents scaling up from our initial 20 pilot sites to over 16% of Tanzania's total 8,549 registered health facilities.

By equipping frontline clinicians at these 1300 facilities, we expect RxVision to:

- Optimize treatment selection for patients through same-day resistance profiles instead of presumptive therapy, improving outcomes. 

- Detect emerging resistance trends up to 4 weeks faster than conventional methods by aggregating data from more decentralized testing sites.

- Strengthen appropriate antibiotic use through on-site training and decision support for an estimated population of over 10 million people served by these health centers.

Targeting 16% of Tanzania's primary care network by 2027 will provide a meaningful scale-up from our pilot while remaining an achievable goal to demonstrate tangible impact for underserved communities through improved infectious disease management.

By 2024, we will complete our ongoing pilot program, refining the technology based on learnings from testing at 20 rural clinics. We aim to validate our integrated decision support platform through these sites, developing strategic partnerships to support scale-up. 

By 2025, we plan to expand operations to an additional 50 clinics across 3 underserved regions of Tanzania, representing approximately 250,000 more end-users. At these sites we will evaluate optimized deployment and training models. Syndicated data analytics will provide broader epidemiological insights. 

In 2026-2027, pending successful pilots and securing ongoing funding, our goal is to make RxVision available to 1,300 primary care facilities nationwide, serving over 10 million people. To achieve this, we will establish regional training hubs, develop cloud-based infrastructure, integrate with clinical record systems, and engage manufacturers for scalable production. 

By the end of 2027, we aim to have transformed AMR surveillance for 16% of Tanzania's population through our decentralized diagnostic networks and data-driven decision tools. Ongoing evaluation will capture social and economic impacts to demonstrate RxVision's long-term transformational potential.

We measure RxVision's success against the following key indicators:

1. Clinical Validation: Percent concordance of AI predictions vs standard testing. Pilot results show 87% accuracy on average. 

2. Turnaround Time: Average hours from specimen receipt to antimicrobial susceptibility profile. Pilots demonstrate a 26 hour reduction vs conventional methods.

3. Treatment Optimization: Percentage of antibiotic prescriptions influenced by our integrated diagnostic-prescribing support. Pilots indicate 90% of prescriptions reviewed were optimized.

4. Operator Training: Pass rates on competency evaluations for clinic technicians performing on-site testing after training on our microfluidics platform and smartphone app. Pilots show an average pass rate of 95%.  

5. Scaling Targets: Number of new clinics and population covered each year to reach national surveillance goals. We expect to expand to 50 more clinics covering 250,000 people by 2025.

Monthly review meetings with clinic staff and regional health administrators provide both quantitative and qualitative data driving ongoing refinement. External program evaluations will capture longer term health and socioeconomic impacts.

Deployment barriers: Limited IT infrastructure in rural areas could hinder device/cloud connectivity. To overcome this, we are researching offline/low-bandwidth algorithms and integrating with existing government networks.  

Funding barriers: Scaling to 50+ clinics will require £1 over 2 years for equipment, staffing, training. We are pursuing partnerships with governments, NGOs and impact investors. 

Supply chain barriers: Sustained production of consumables like microfluidic chips needs in-country capacity. By involving local manufacturers early, we aim to co-develop scalable solutions.

Cultural barriers: Gaining community trust takes time. Our Tanzanian team leads culturally sensitive engagement and pilots include qualitative research on acceptability. 

Policy barriers: Approvals for national rollout require extensive evaluations. We work closely with regulatory bodies during piloting to streamline future clearances.

By tackling barriers proactively through technological innovation, local partnerships, open collaboration and pilot demonstration of benefits, we aim to realize RxVision's full nationwide potential on an accelerated timescale. Flexible plans and stakeholder buy-in will also help navigate unexpected challenges.

We are applying to The Trinity Challenge because it is well positioned to help us overcome key barriers:

Access to funding is our primary barrier currently limiting piloting, evaluation and scaling of RxVision. The £1M award size from Trinity Challenge is perfectly aligned to support our 3-year operational plan outlined above. 

Deployment barriers around limited rural infrastructure will be addressed through the Challenge's focus on applied, real-world impact. The funding and partnership opportunities it provides can help integrate RxVision with existing healthcare networks.

Cultural barriers are a focus of the Challenge approach through its emphasis on community-driven design. Working with Trinity experts can strengthen how we engage stakeholders and ensure the solution meets local needs. 

Policy barriers will be reduced through potential connections with Challenge partners in Tanzania that can fast-track engagement with regulators. 

The multi-disciplinary support provided on areas like technology, operations and strategy will also help navigate unexpected challenges as RxVision scales. We believe the Trinity Challenge is ideal to help us maximize our potential to transform AMR care.

Some key organizations I would like to collaborate with through The Trinity Challenge include:

- Wellcome: As the anchor funder of the Challenge, collaborating with Wellcome could help accelerate large-scale clinical validation, policy engagement, and pathway to national implementation. 

- Patrick J McGovern Foundation: Their expertise in AI/data solutions applied to global health challenges would be invaluable to optimizing RxVision's diagnostic platform and data capabilities. 

- Ineos Oxford Institute: Working with their world-leading scientists and surveillance networks could help validate RxVision's real-world public health impact and prioritize further R&D. 

More broadly, collaborating with Challenge partners through mentoring and resources could help overcome barriers. Members' Africa/Asia expertise could improve community involvement. Their funding experience may fast-track our Series A. Diverse technical advisors may optimize our solution design for diverse settings. Members' policy networks could advance enabling policies/regulations. Overall, Challenge collaboration presents ideal networking and support opportunities to refine, scale, and sustain RxVision's long-term goals.