TextCare

TextCare is a mobile-based community surveillance platform that generates novel data on antibiotic use and resistance by enabling citizens to report via SMS. Integrating this with other data sets provides actionable insights on transmission dynamics to drive targeted One Health policies improving antibiotic access and outcomes at local levels.

Julieth Shayo, CEO and Founder of Textcare, will lead the TextCare solution. As an experienced public health expert and social entrepreneur, she will oversee project implementation, management, and presentation.

The major data gaps that exist around understanding the scale and drivers of antibiotic resistance at the community-level in low-resource settings pose a significant problem for effective response. While the majority of antibiotics are utilized outside of formal healthcare contexts in these environments, we have very limited insights on usage practices, emerging resistance patterns, and transmission dynamics from underserved populations.

According to the WHO, at least 70% of all antibiotics globally are sold in low and middle-income countries, often over-the-counter and without medical supervision. Yet community-level data on resistance remains scarce, particularly across humans, livestock and the environment. This lack of evidence from where antibiotics are most utilized drastically limits our ability to design targeted interventions.

The communities we aim to engage in rural Tanzania exemplify these challenges. As a region with poor access to healthcare and widespread informal antibiotic distribution, the rural communities face elevated AMR risks. However, there is little local data available. If left unaddressed, such information gaps will undermine global progress on this growing public health threat. It is estimated that by 2050, antimicrobial resistance could result in 10 million annual deaths without improved surveillance and action - many in similar resource-constrained settings.

Our solution primarily serves rural communities in Tanzania who have limited access to formal healthcare and antibiotic stewardship resources. Within these populations, we aim to support:

- Individuals seeking to better manage antibiotic treatments for themselves and their families through SMS reminders and education. This addresses needs around adherence, understanding proper usage, and controlling spread of resistance. 

- Local livestock farmers who struggle with antibiotic access and lack awareness on prevention of anti-AMR contamination in animal husbandry. Our platform raises these critical issues.

- Frontline community health workers who are challenged by sparse local data for targeted programming. TextCare generates evidence to guide their response efforts.

To understand these audiences holistically, we are conducting initial in-person field visits and focus group discussions. We explore barriers faced, preferred communication channels, and priorities around antibiotic access and knowledge. Feedback is directly incorporated into the user-centric design of TextCare's SMS interfaces and content. 

As the solution is developed and tested, we will maintain close engagement with pilot communities and local leaders to continuously refine based on real-time user insights, expectations, and emerging needs. This participatory approach aims to foster ownership and sustainability.

Our solution directly provides the public good of open knowledge and evidence to guide effective action against AMR. 

Through TextCare's SMS reporting interface and integrated analytics platform, we generate novel, community-level insights into antibiotic usage practices and emerging resistance patterns in remote, underserved populations. This rich, context-specific data fills important gaps in our global understanding of AMR transmission dynamics at the frontlines. 

All epidemiological analyses and trend visualizations from the data are made freely accessible to local health stakeholders and the public through our interactive online dashboards. The anonymized, aggregated information helps identify key challenges, optimize resource allocation and empower communities themselves to contain spread.

Additionally, we plan to publish peer-reviewed white papers sharing our methodological approach, findings and learnings from the pilot phase with the broader scientific and policymaking communities. This new evidence aims to advance the development of targeted, localized intervention models and surveillance strategies for resource-limited settings worldwide. 

Through openly accessible knowledge generation and dissemination, our solution directly supports progress towards global public health goals of improving access to effective antibiotics and containing antimicrobial resistance for current and future generations.

Our solution aims to create tangible impact for 50,000 people in 10 rural communities in Tanzania by:

Activities (Year 1): Collecting community-reported SMS data from 2,000 individuals annually and integrating clinic records. 

Short-term outcomes (Year 2): Empowering 10 local health workers to promptly address emerging hotspots and adjust care for 5,000 patients each year based on new evidence generated within 6 months.  

Intermediate outcomes (Year 3): Improving antibiotic knowledge among 1,000 at-risk individuals each year, indicated by a 30% increase in scores on yearly knowledge assessment surveys.

Intermediate outcomes (Year 5): Reducing self-reported unsafe use and sharing of leftover antibiotics by 20% among pilot communities through biannual SMS education campaigns.

Long-term impacts (Year 10): Curtailing the emergence and spread of resistance in the region by an estimated 15-20% through optimized public health programs informed by 5 years of grassroots evidence generation, potentially saving 100 lives annually by limiting resistant infections.

By engaging citizens to collect and share localized data, our iterative solution aims to have measurable short, intermediate and long-term impacts on AMR containment within vulnerable communities over the outlined timeframe.

Over the next year, we plan to scale our impact as follows:

- Expand TextCare to 3 new rural communities, adding 600 new reporting users
- Integrate vaccine registry and climactic data for enhanced analyses
- Publish our pilot findings to inform the research community
- Train 20 additional local health workers on using the dashboard 
- Send biweekly educational messages to all reporting users
- Conduct annual surveys to measure intermediate outcomes

Within 3 years, our aim is:

- Reach 15,000 individuals across 10 communities with the SMS platform
- Automate identification of resistance hotspots through machine learning  
- Partner with livestock owners to track antibiotic exposures 
- Establish a feedback loop to regularly refine national treatment guidelines
- Detect early disease outbreaks leveraging integrated symptom reports
- Publish 2-3 more papers elucidating socio-cultural drivers of AMR
- Measure lives saved and infections averted against projections 

Regularly improving the platform based on user and stakeholder input, we believe scaling accessibility and utility of the community-generated data over time will transform approaches to AMR response- empowering localized, prevention-oriented strategies for public health resilience.

We measure success against our goals through both quantitative and qualitative indicators:

Quantitative:
- Percentage change of SMS reports received monthly ( increased 30% in pilot to 50% per month)  
- Percentage change in antibiotic knowledge scores from surveys (increased 20% in pilot pre-post)
- Actionable insights generated for health workers monthly (doubled in pilot to 20 insights) 

Qualitative:  
- Frequency of dashboard usage and feedback from health stakeholders  
- User experience feedback and iteration (interface improvements doubled users in pilot)
- Community endorsements and requests to expand platform's reach 

Progress will also be measured against targets like:

- Onboarding 7,000 total users across pilot communities by Year 2
- Detecting 5 new localized resistance patterns by Year 3
- Health policies/guidelines adjusted within 6 months of new datasets 

We conduct quarterly reviews against metrics, annually surveying 750 users and 20 workers. Pilot achievements provide evidence goals are impactful and help strengthen community relationships/buy-in critical to sustained cooperation. Measuring both tangible outputs and perceptions of value will track solution and societal impact over time.

Over the next year, key barriers include:

- Infrastructure: Intermittent network coverage hampering SMS delivery, overcome through caching reports locally and scheduled batch uploads. 

- Financial: Limited funds for expansion, addressed through seeking small government/foundation grants.

Within 3 years:  

- Data quality: Ensuring accurate integrated data as scale increases, mitigated through automated validation checks and regular cleaning/merging.  

- Policy: Guidelines not promptly adjusting to new evidence, engagement of high-level stakeholders for feedback loops will be critical. 

- Connectivity: Potential new areas lacking networks, planning offline versions of key education materials.  

- Sustained participation: Fatigue setting in, incentivizing continued reporting with point-based rewards redeemable at partner clinics.

Key enablers include community trust established in pilot communities advocating for value, technical groundwork already in place, and collaboration with implementing partners experienced navigating local contexts and connecting to regional bodies. By proactively addressing such multi-level challenges, our iterative approach aims to maximize scalable impact of this sustainable surveillance model.

We are applying to The Trinity Challenge because it offers a unique platform to collaborate with leading experts and organizations in addressing global health challenges, such as antibiotic resistance. The Trinity Challenge provides an opportunity to access resources, expertise, and networks that can help us overcome barriers in implementing our SMS-based community surveillance system.

One significant barrier we face is limited resources for scaling up our solution and integrating it with existing health systems. The Trinity Challenge can provide funding and technical support to scale our project, ensuring its sustainability and impact. Additionally, by connecting us with other members and partners, The Trinity Challenge can facilitate knowledge exchange and collaboration, enabling us to leverage best practices and innovative approaches in combating antibiotic resistance.

Furthermore, The Trinity Challenge's focus on interdisciplinary collaboration aligns with our approach, which involves engaging stakeholders across sectors to address complex health issues. Overall, The Trinity Challenge represents a valuable opportunity to amplify our efforts in combating antibiotic resistance and advancing global health security.

We would like to collaborate with organizations such as the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the World Organization for Animal Health (OIE) to initiate, accelerate, and scale our solution. Collaboration with these organizations would provide access to their expertise, resources, and global networks, enabling us to enhance the impact and reach of our SMS-based community surveillance system for antibiotic resistance.

Partnering with these organizations would also facilitate the integration of our solution into existing global health frameworks and initiatives, such as the Global Action Plan on Antimicrobial Resistance. This collaboration would help us align our efforts with international standards and guidelines, ensuring the sustainability and effectiveness of our approach. Additionally, working with these organizations would provide opportunities for knowledge exchange and capacity building, further enhancing our ability to address the challenges of antibiotic resistance at a global scale.