RxOptimize

RxOptimize empowers Tanzanian pharmacists through tailored regulatory practices and incentives/disincentives to optimize antimicrobial dispensing while ensuring access. This enhances antimicrobial stewardship and fosters provider collaboration using community pharmacy data to inform policies safeguarding drug effectiveness and public health.

Greener Mbata, Managing Director of RxOptimize Solutions Tanzania, will spearhead implementation and stakeholder engagement to optimize antimicrobial dispensing in Tanzanian pharmacies.

Antimicrobial resistance poses a serious threat in Tanzania. Infectious diseases such as pneumonia, tuberculosis and HIV/AIDS place a heavy disease burden on the population, making access to effective antibiotics critically important for public health. However, current practices in Tanzania promote the unnecessary and inappropriate use of antibiotics. A 2019 study found that a staggering 62% of antibiotics in Tanzania were dispensed without a prescription from pharmacies. This is primarily due to a lack of regulation and inadequate training of pharmacy staff. Such widespread overuse and misuse accelerates the development of drug-resistant bacteria undermining global efforts to preserve antibiotic effectiveness. 

If antimicrobial resistance is left unaddressed, the consequences will be dire for Tanzania’s development and public health gains. Estimates suggest that by 2050, drug-resistant infections could cost the country $100 million annually in healthcare costs and lost productivity. It is projected that antimicrobial resistance could drive 24,000 Tanzanians into extreme poverty each year by 2050. On a global scale, the threat is even greater with estimates of 10 million premature deaths and $100 trillion in economic losses predicted by 2050 if no remedial action is taken according to WHO.

Our solution primarily serves the people of Tanzania by addressing the pressing threat of antimicrobial resistance. More specifically:

- Patients will benefit from improved access to appropriate antibiotic treatment through optimized pharmacy practices. 

- Pharmacists are empowered to better manage antimicrobial use while engaging in rewarding stewardship activities. Their needs are being understood through formative discussions with the Pharmacy Council.

- The Ministry Of Health (MOH) and regulators can leverage novel data and multi-stakeholder collaboration to design targeted policies. We are engaging them to ensure the solution supports national strategies.

- Healthcare workers such as clinicians will be able to refer patients to accredited pharmacies and work as partners in stewardship. 

- Communities will receive education promoting prudent antibiotic use and responsible disposal. Community advisory panels will provide input.

By addressing the needs of multiple groups through cooperative design and evaluation, we aim to establish sustainable practices that serve all Tanzanians in mitigating antimicrobial resistance.

Our solution directly provides the public good of an open-access national antimicrobial resistance knowledge database and analytics platform. 

Leveraging pharmacy dispensing records, clinical data and connected device insights collected through our stewardship model, we generate a unique integrated data resource on antimicrobial access and resistance patterns at the community level across Tanzania. However, the full value of this data is only realized through open sharing and collaborative analysis by diverse stakeholders.

Therefore, our antimicrobial resistance database will be hosted on an open-source architecture and all aggregate analytical outputs will be freely accessible online without fees or registrations required. This represents an unprecedented public good, as currently no similar comprehensive data resource capturing community antibiotic use exists for Tanzania. 

By unlocking novel insights into resistance hotspots, consumption trends, health outcomes and impacts of interventions, the open database fuels more effective, evidence-based policies and programs nationally. It also supports antimicrobial-related research and benchmarking globally. Overall, optimizing antibiotic use through cooperative, data-driven solutions benefits the health and wellbeing of all people in Tanzania and around the world.

Our solution aims to have a significant public health impact in Tanzania by rationalizing antibiotic access and slowing the development of antimicrobial resistance. 

Activities: Over a three-year implementation period, we will enroll 450 pharmacies serving 1.5 million patients into our optimized antibiotic stewardship program. 

Outputs: Participating pharmacies will document dispensing data for an estimated 500,000 antibiotic transactions annually using our digital platform. This will generate robust datasets on consumption patterns, resistance trends, and impact indicators.

Outcomes: Based on pilot results showing a 12-30% reduction in resistance associated with similar programs, we expect nationwide implementation could prevent at least 15-40% of new resistant infections annually, or 30,000-80,000 cases. 

Impact: By preserving antibiotic efficacy, vulnerable groups such as the estimated 1.4 million Tanzanians living with HIV/AIDS will benefit. Research shows a 15% increase in antimicrobial resistance is associated with nearly 25,000 additional HIV/AIDS deaths per year in Africa. Our solution could potentially save thousands of lives, alongside $10-25M in annual healthcare costs attributed to antimicrobial resistance by 2023 estimates. 

Wider economic impacts include increased productivity due to fewer infections and deaths. The WHO calculates antimicrobial resistance will cost the global economy $100 trillion by 2050 if left unaddressed. 

Over the next year, we aim to complete our proof of concept by:

- Refining the digital platform through pilot testing in 12 pharmacies across 2 regions.
- Finalizing stewardship guidelines and clinician training curricula.
- Evaluating initial round of data collection to test analytics functionality.

In year 2, we will begin scaled implementation through:

- Onboarding 150 new pharmacies for full national coverage across 5 regions
- Launching collaborative policy working groups with regulatory bodies   
- Developing public health campaigns reaching 500,000 citizens

By year 3, we target to have:

- Fully transitioned 450 pharmacies onto the optimized dispensing model
- Established the national AMR database leveraging 1 million longitudinal dispensing records
- Conducted evaluations demonstrating 15-30% reductions in resistant infections across early adopter regions

Over the 3 years, we aim to establish sustainable systems enabling nationwide upkeep of the digital surveillance network and policy changes cementing Tanzania's position at the forefront of combating AMR in Africa.

We envision our model serving as a blueprint for cooperative solutions optimizing antibiotic access globally through learning health systems powered by open data.

We have established the following key performance indicators to measure success:

1. Pharmacies enrolled: Target is 100 in year 1, 250 by year 2 and 450 Pharmacies. Currently we have engaged 12 in our proof of concept.

2. Patient records captured: Aim for 25,000 in pilot, 100,000 by year 2, 1 million total. Pilot showed average of 50 records/pharmacy/month. 

3. Guideline compliance rate: Goal is 80% by year 3. Pilot demonstrated baseline of 45% pre-training. 

4. Reduction in resistant infections: Ultimate target 15-30% nationwide by year 3. Pilot estimates 12% drop based on thermometer checks.

5. Stakeholder feedback: Surveys will track awareness, skills and support for policies gaining 90% approval target. Pilot feedback was overall positive.

Additionally, we will measure cost-savings realized by health systems and GDP effects using WHO models, as well as publish findings at international conferences and in peer-reviewed journals. 

Regular evaluation against progress on enrolment, data collection volumes and changes in key public health indicators will allow us to refine implementation to maximize impact.

Some key barriers we anticipate and plans to address them:

Regulatory - Pharmacies require licensing changes to fully participate. We will pursue stakeholder engagement, pilot results and advocacy to revise laws/policies. 

Financial - Upfront costs of platform development and enrollments. We are applying to global funds supporting AMR innovations and will prove return on investment to scale sustainably. 

Technical - Reliable digital connectivity and IT skills. Our solution utilizes low-bandwidth design and ongoing digital training. Offline functionality ensures continuity.

Adoption - Changing behaviors takes time. We will incentivize early adopters and emphasize clinical, economic and ethical arguments for all pharmacists to become stewards. 

Data security - Protecting patient privacy. The platform incorporates built-in safeguards like anonymization and access controls. Partnership with regulatory bodies provides oversight.

To overcome infrastructure barriers to implementation, we have established cooperative relationships with prominent medical associations, NGOs and government agencies invested in public-private partnerships. Their buy-in and resources will be leveraged for guidance, promotion and help addressing challenges - whether through pilots in access points or advocacy. With a collaborative approach, we aim to systematically work through anticipated limitations.

We are applying to The Trinity Challenge because it is perfectly aligned with our goals of developing an innovative solution to curb antimicrobial resistance in Tanzania, while also directly addressing many of the key barriers currently limiting our impact. 

The catalytic funding from Trinity could help us overcome financial barriers to implementing our proof-of-concept pilot, generating early data to prove the model's viability. It would remove the constraint of lack of funds currently preventing us from commencing real-world testing. 

Additionally, the partnerships, guidance and convening power that Trinity provides would help us surmount regulatory barriers - connecting us with policymakers to build support for necessary licensing and data sharing reforms. 

The technical expertise resources at Trinity could also help strengthen our platform architecture and data analytics capabilities, overcoming technological limitations to impact measurement. 

Finally, the global visibility and credibility that comes with being a Trinity Challenge winner would boost our adoption efforts - breaking down behavioral barriers by generating buzz and buy-in around our solution nationwide. 

In short, successful selection by Trinity Challenge could lift the major constraints around funding, policy engagement, technology and awareness - empowering us to realize our full potential in solving this crisis.

Here are some key organizations I would aim to collaborate with to help accelerate and scale my solution for pandemic preparedness and response:

- World Health Organization: As the leading global public health agency, the WHO has unmatched expertise in global health security and epidemic response. Collaborating with them could help ensure our solution is aligned with international standards and implemented where it's needed most. 

- National public health agencies: Working directly with agencies like the CDC, NIH, and PHE would allow us to tailor our solution based on their operational needs and deploy it within their existing response frameworks. 

- Biopharmaceutical companies: Companies researching and producing medical countermeasures like vaccines, tests and treatments hold vital knowledge and resources. Partnering with them could help streamline supply chain integration and ensure our solution supports the entire product development cycle. 

- Philanthropic organizations: Foundations focused on global health security could provide funding to test and refine our solution through pilot programs. Engaging groups like the Gates Foundation may also open doors to new technical/scientific collaborators.

- Academic institutions: Universities and research centers studying diseases and emergency response would offer subject matter expertise vital for ongoing evaluation and enhancement of our platform.