Digital Tools to Tackle Antibiotic Misuse & Resistance in Bangladesh

The project targets reducing antibiotic misuse and antimicrobial resistance in Bangladesh community settings through surveillance, awareness, and rational use promotion via digital tools. It focuses on healthcare workers, employing education, stewardship teams, and a smartphone support system, with a key focus on popularizing an evidence-based digital system for antimicrobial use.

Dr. Fahmida Chowdhury, Associate Scientist, Lead AMR research group, Project Coordinator, Emerging Infections, icddr,b

Antimicrobial Resistance (AMR) is a critical global health issue, exacerbated by misuse of antibiotics, leading to resistant pathogens and treatment failures. In LMICs like Bangladesh, the situation is worsened by factors such as inadequate AMR awareness, irrational Antimicrobial Use (AMU) across sectors, unrestricted antibiotic access, and poor regulation. Widespread antibiotic misuse in humans, poultry, and aquaculture underscores the 'One Health' importance of AMR. Key challenges in Bangladesh also include limited diagnostic access, lack of AMU and AMR data, and sociocultural practices. Antimicrobial stewardship aims to reduce AMR's impact on public health. Research on intervention effectiveness across the One Health spectrum for AMU and AMR in Bangladesh is limited. The national AMR digital dashboard fails to fully embrace this approach, missing key community and environmental data. This highlights the critical need for better integrated surveillance to improve AMR management. Our project targets antimicrobial stewarship in LMICs like Bangladesh by launching a digital platform and smartphone app for healthcare practitioners, enabling evidence-based antibiotic prescribing and AMR management. Utilizing comprehensive interventions package including AI, Surveillance Data, and GIS, we aim to improve diagnostics and AWaRe classification-based antimicrobial treatment through real-time data in a established model AMR containment Upazila (sub-district).

Our solution targets a wide array of stakeholders in healthcare and animal husbandry across Bangladesh to address rational Antimicrobial Use (AMU) and Antimicrobial Resistance (AMR). This includes healthcare and veterinary professionals in community settings, traditional healers, animal feed dealers, Community Health Workers (CHWs), pharmacy staff, consumers, animal farmers, pharmaceutical professionals, and civil society organizations like NGOs. We are developing a digital tool to support rational antibiotic use, education on AMR, responsible antibiotic dispensing, and mindful antibiotic development and distribution. To tailor this tool to the needs of our diverse audience, we're engaging them through surveys, interviews, and focus groups, collecting valuable insights on their experiences and expectations regarding AMU and AMR. Moreover, we're partnering with civil society organizations to conduct awareness workshops and seminars, ensuring our tool is both effective and user-friendly. This collaborative and feedback-oriented approach guarantees that our digital solution directly addresses the challenges faced by our target groups, fostering their active engagement in combating AMR in Bangladesh.

This project introduces digital innovations to enhance antibiotic prescribing and antimicrobial stewardship in LMICs, providing a significant public good through open-access knowledge and data. By integrating AMU and AMR data within a freely accessible dashboard for healthcare professionals in Bangladesh, the initiative offers real-time insights into microbial resistance patterns, facilitating informed prescribing decisions. Despite potential challenges in solely relying on digital data, this method represents a significant advancement in antimicrobial stewardship efforts. The project not only aims to improve prescribing practices among community healthcare workers but also extends critical information across One Health sectors, enhancing AMR awareness and supporting evidence-based policymaking through educational resources and a comprehensive data integration strategy. Anticipated outcomes include a reduction in antimicrobial misuse and resistance and an increase in education about appropriate antibiotic use, contributing to a scalable and sustainable model for future expansion. This initiative, by providing unrestricted access to AMR data and stewardship resources, exemplifies a public good accessible globally under fair terms, aligning with the Trinity Challenge's goal of delivering public benefits in the fight against AMR.

Our digital solution aims to enhance antimicrobial stewardship in LMICs, focusing on Bangladesh, by providing healthcare professionals with real-time data on antimicrobial use (AMU) and resistance (AMR). It facilitates informed antibiotic prescribing decisions, targeting particularly underserved and vulnerable communities. By addressing the challenges of limited diagnostics and awareness, the project enhances local healthcare providers' capabilities, promoting the rational use of antibiotics and reducing resistance risks. This approach aims to mitigate AMR's impact, improving public health outcomes through education and targeted interventions, offering significant benefits to vulnerable populations. Our digital solution for enhancing antibiotic stewardship in LMICs, particularly in Bangladesh, is grounded in activities such as developing digital tools and conducting educational campaigns. These efforts aim to improve healthcare professionals' antibiotic prescribing practices by providing real-time AMU and AMR data, thereby reducing irrational use and combating AMR. The efficacy of such interventions is evidenced by literature, including Thakral, Y., Sahay, S., & Mukherjee, A. (2022) and Al Munajjam, M. F. M., et al. (2022), which highlight the positive impact of digital health interventions on AMR. Early feedback from healthcare professionals suggests significant potential for changing prescribing practices, underscoring community support and the promise of lasting benefits.

Our initiative in Bangladesh utilizes digital innovations to combat antimicrobial resistance (AMR) and usage (AMU), emphasizing data integration across One Health sectors. We aim to educate healthcare workers on these digital tools and refine them for better accessibility and functionality. The project includes collecting baseline AMR and AMU data to promote rational antibiotic use among healthcare providers. Over 23 months, we will implement an educational strategy and establish a Community Antimicrobial Stewardship Team (CAST) to ensure responsible antimicrobial practices. Efforts to increase community awareness on AMR and encourage rational antibiotic use will be supported by AI for more effective data analysis. Collaboration with stakeholders for training will enhance digital tool adoption, significantly improving antimicrobial stewardship and public health by mitigating AMR. Our approach, integrating technology with community engagement, aims for a lasting impact against AMR through comprehensive healthcare worker training and public education. Continuous evaluation will track digital tool effectiveness and AMR/AMU changes, guiding strategy adjustments and national stewardship enhancements. This scalable, adaptable solution is designed for broader application, based on initial successes and stakeholder partnerships, aiming to improve antibiotic practices and reduce AMR nationally.

Central to the current initiative are efforts to assess the current AMR/AMU landscape, establish a comprehensive One Health surveillance system, develop digital tools for real-time AMR/AMU visualization, and advocate for rational antibiotic use. Anticipated outcomes include a well-documented understanding of AMR/AMU, a functional surveillance system, enhanced community awareness, and a shift towards rational antibiotic practices, ultimately leading to reduced antimicrobial usage and resistance. Critical deliverables encompass a detailed AMR/AMU assessment, an integrated surveillance system, effective digital monitoring tools, and widespread community engagement, with success measured by a comprehensive AMR/AMU report, system functionality, digital tool efficacy, and increased public awareness within a 36-month timeline. Our evaluation strategy combines qualitative and quantitative indicators to gauge digital tools' impact on antimicrobial stewardship and AMR awareness. Key performance indicators include digital tool adoption rates, alignment of antibiotic prescribing with guidelines, reduction in broad-spectrum antibiotic use, and growth in AMR awareness. Early detection of AMR outbreaks and feedback on the tools' impact on clinical decisions also play a crucial role. A preliminary survey showed significant interest in a digital solution, increased AMR awareness among healthcare providers, and greater confidence in prescribing decisions.

Our initiative aims to enhance antimicrobial resistance (AMR) management in low- and middle-income countries (LMICs) by introducing advanced digital tools for data collection on microbial isolates, antimicrobial use (AMU), and cross-sector samples. We face challenges, including socio-cultural resistance due to a lack of familiarity with such technologies among both community members and healthcare professionals, who often depend on traditional knowledge and experience. Our solution involves comprehensive education and awareness campaigns to encourage the adoption of evidence-based patient management practices. Technical hurdles, notably inconsistent internet access, will be addressed by regularly updating our smartphone application and providing support for users with personal laptops. Collaboration with governmental and local authorities is crucial; thus, we plan to establish a Community Antibiotic Stewardship Team (CAST) to ensure cooperative training and motivation across stakeholders, aligning with IEDCR's national AMR surveillance efforts. Financial and resource limitations also pose a barrier, which we intend to overcome through leveraging existing partnerships and seeking additional support from global health organizations. By strategically tackling these challenges, we anticipate the successful implementation of our digital tools, significantly advancing AMR management and raising awareness in LMICs within the next year and beyond.

We are applying to The Trinity Challenge due to its commitment to harnessing collective expertise in addressing global health emergencies, specifically antimicrobial resistance (AMR). The Trinity Challenge represents an opportunity to access not just funding but a platform for collaboration, innovation, and scaling effective solutions. Our project confronts barriers such as the need for advanced digital tools, capacity building for healthcare workers, and establishing a comprehensive surveillance system across One Health sectors in LMIC contexts. The Trinity Challenge can help us overcome these by providing the resources necessary to develop and implement our digital prescription tool, facilitate cross-sectoral data integration, and enhance stakeholder engagement through targeted education and training programs. Moreover, The Trinity Challenge's network of partners offers invaluable expertise and knowledge sharing, which can accelerate our progress and improve our solution's efficacy. It provides a framework for us to refine our approach based on global best practices and emerging technologies. By participating in this challenge, we aim to leverage the collaborative environment to address these barriers effectively and create a scalable, impactful solution for rational antimicrobial use and AMR containment.

The project aims to enhance the impact of its digital solution for rational antimicrobial use (AMU) in Bangladesh through collaboration with key entities. Desired collaborators include international public health organizations such as the World Health Organization (WHO) and UNICEF, offering access to global best practices and networks for wider dissemination. Partnership with pharmaceutical companies could integrate educational modules and explore co-funding opportunities. Collaboration with telecommunications companies would leverage mobile networks for wider accessibility and joint SMS campaigns. Engaging community-based organizations (CBOs) provides insights into community needs and trusted channels for promotion. Collaboration with The Trinity Challenge offers expertise, connections, and mentoring for scalability. Benefits include enhanced expertise, scalability, financial sustainability, community integration, and alignment with global best practices. Through these collaborations, the project aims to create a impactful digital solution promoting rational AMU in Bangladesh.