eLABS-OneHealth

eLABS, an already scaled digital health innovation in Zambia from this group, will develop a One Health module to integrate disparate data sources from human, animal, and agriculture sectors into a single database from which user-friendly dashboards and reporting can be optimised, making AMR monitoring more accessible and effective.

Portia Sejake, Program Lead, Wits Diagnostic Innovation Hub. Leads Regional Implementation Programs. Portia will be supported by two Clinical Microbiologists: Prof. A Duse (SA) and Dr David Ojok (Zambia).

We're enhancing the Zambian National Public Health Institute's (ZNPHI) capabilities by centralizing human, animal, and agricultural AMR/AMU data into eLABS, a unified digital platform. Two-thirds of antibiotic usage is in the animal/agricultural industry and given that the mortality due to AMR is a serious risk to global health and biosecurity, data are needed to guide policies, antibiotic usage practices, education, and antimicrobial stewardship. As the AMR Secretariat, the ZNPHI leads the One-Health Program to mitigate AMR's impact. eLABS aims to enrich policy-making and targeted actions against AMR by providing comprehensive, data-driven insights. eLABS will combine digital and paper-based data from human bacterial infections in communities and hospitals, along with animal and agriculture. Data sources span the Zambia Medicines Regulatory Authority (ZAMRA), healthcare facilities, and farmers, covering pharmaceuticals, community health, and agriculture. eLABS is already operational in 1412 healthcare facilities across nine provinces, it significantly aids human health. However, the challenge lies in the paper-based records of animal and agricultural data, hindering timely access for clinicians, veterinarians, farmers, and ZNPHI, for effective national planning and rapid response. Digitizing and consolidating this data into eLABS is critical for a real-time, holistic view of Zambia's AMR situation, enabling more efficient and informed decisions.

Our innovative solution digitizes and centralizes antimicrobial resistance (AMR) data for Zambia's MOH and the ZNPHI, streamlining access for clinicians, veterinarians, and farmers. This unified database enhances near real-time remote monitoring through advanced dashboards, facilitating policy formulation and targeted AMR interventions. Initially focusing on the well-charted health data, we aim to extend our evaluation to animal health and agricultural sectors, identifying and integrating AMR, AMC, and AMU data sources into the eLABS platform for comprehensive national and global surveillance. Our approach includes close collaboration with the MOH, ZNPHI, and OH sector ministries including the Ministry of Fisheries and Livestock (MFL) to identify their challenges, ensuring eLABS is tailored to meet their needs and those of their clients. By co-developing eLABS with stakeholders, we're setting a foundation for a One Health digital system that not only meets current needs but is adaptable for future AMR strategy enhancements, ensuring continuous and effective monitoring and management of AMR in Zambia. Implementation of eLABS will support the mandate of ZNPHI by embedding analytics with early warning alerts to detect disease outbreaks in communities and thus enabling near real-time sector-wide response.

Our proven technology has in the past provided near real-time access to results for healthcare facilities, enabled per-sample tracking, and reduced errors in transcription due to the “digitize once” approach done at the source. eLabs is deployed in 9/10 provinces in Zambia, benefiting the care and treatment of 1,828,963 patients at MOH facilities. This data (access to dashboards and integration into legacy systems, including global surveillance systems) can be shared upon authorisation from local regulators. A costing analysis of eLABS was conducted in South Africa (HIV VL program), in 2023. This analysis concluded that eLABS significantly improves the tracking of specimens along the value chain, resulting in improved intermediary outcomes when compared with the standard delivery of care model. These improvements have the potential to significantly reduce the number of resources being used during implementation, reduce wasteful expenditure associated with increased rejection rates, and improve overall turnaround time resulting in improved service delivery and patient experience. The findings from all three analyses overwhelmingly suggest that the adoption of eLABS results in improved HIV-VL suppression.

eLABS benefits both the general and underserved populations by digitizing data to cut waiting times for test results from days to hours, facilitating quicker diagnoses and treatments, especially in remote or low-resource areas. Our efforts, such as deploying the AMR module, training healthcare workers, and integrating with existing systems, lead to improved data integration, faster lab results, more accurate data handling, and improved disease surveillance and management. These efforts result in timely interventions, reduced untreated conditions, and enhanced patient management, supporting effective antimicrobial use and disease control through a One Health approach. This intervention provides vital data for targeted actions against antimicrobial misuse, leading to shorter hospital stays, better hospital outcomes, and improved quality from farm to fork. Evidence from South Africa (February 2023) confirms that digital health interventions like eLABS significantly enhance healthcare delivery and patient outcomes, with notable reductions in diagnostic turnaround times and increased HIV viral load suppressions. Thus, eLABS proves to be a pivotal healthcare solution, especially where access to prompt and accurate health services is limited.

Year 1: The solution will be piloted in Lusaka province, utilizing one animal and one human laboratory linked to 20 healthcare facilities, catering to patients in need of antimicrobial medication. The animal laboratory conducts active AMR surveillance by collecting samples from farms and conducting antimicrobial susceptibility testing (AST) while the human laboratory tests clinical samples from patients. Both types of facilities will undergo assessments during the pilot to determine their data storage capabilities(  electronic/paper-based). Paper-based data will be converted to electronic format and integrated into the eLABS. Data analysis and dashboard creation will take place eLABS platform to provide stakeholders in One-Health with timely AMR information. A similar approach will be applied to veterinary and agricultural testing laboratories to incorporate data into the eLABS; unified data source for analysis across the One-Health platform. Years 2-3: Upon completion of pilot, additional laboratories and healthcare facilities will be added to eLABS, expanding to 9/10 provinces. Depending on budget,  scaling-up can be replicated to extend AMR surveillance coverage through enhanced data collection, analysis, and visualization accessible to stakeholders. With increased coverage, there will be greater availability of AMR data, enabling nationwide review of AST results and defining AMU for the entire country.

Key indicators will be pre-identified with the MoH, ZNPHI, MFL, and other stakeholders. Human Impact: Enhanced AMR data will involve assessing data such as a reduction in turnaround time of AST results and AMU. Animal/Agricultural/Environmental Impact: Reduction in response time to agriculture AMR threats will be quantified by comparing the time taken for the system to detect emerging threats, before and after implementation. Improved accuracy in identifying/analyzing AMR trends will be assessed by evaluating eLABS' ability to provide insights into resistance patterns over time. The percentage increase in detecting emerging resistance patterns will be determined through regular analysis outputs. The adaptability of the system to new agricultural AMR threats will be measured through updates and data from system logs. The percentage increase in integrated datasets from animal and crop sources will be documented. Animal Health Impact: Veterinary surveys will monitor disease incidence, mortality rates, AMU, AMR, and records will be analyzed for trends pre-and post-intervention. Economic Impact: Data on the percentage increase in integrated datasets will be collected, highlighting the eLABS capacity for comprehensive analysis. Success stories of effective integration will be documented. Socio-Economic Impact: Evaluation includes tracking healthcare practitioners' information access and measuring to inform decisions. 

To successfully implement a solution for the public sector, several factors needed to be considered which may be construed as barriers if proper protocols are not observed. The possible barriers include navigating several stakeholders, buy-in from stakeholders, end-user adoption, and sustainability. Stakeholders include MoH, donors, implementing partners, other ministries, and the private sector. It can be a challenge to coordinate all parties to get buy-in and approval. Through our experience, we have managed to fully understand all the protocols required including all the recommending and decision-making committees like the lab technical working group (TWG). Our continued in-country stakeholder engagements have strengthened our relationships and have allowed us to easily get our requests through and approved. To overcome the end-user adoption barrier, we apply our mature application development process which employs a user-centered design approach coupled with end-user usability evaluations and continuous system enhancements. We also apply the train-of-trainer strategy to ensure capacity building and sustainability.

Our team is applying to primarily access a community of like-minded colleagues who share a common goal of improving access to improve global health through digital health innovations. Through this community, we will engage, learn from each other, and hopefully gain access to other partners who will assist us in leapfrogging our technology through global access mechanisms. Furthermore, we are hoping that Solve would be able to assist us with partners who can help in investing in sustainable commercial modelling for eLABS.

SAMRC: We are collaborators in many other research projects, however, we are not fully engaged in eLABS. Wellcome Trust: Funding support for Climate and Health initiatives. CHAI, to further leverage their costing and technical information expertise, and reach across the African continent. Microsoft and/or Google to assist in increasing global access, provide mentorship to the eLABS technical team, provide insights for potential streamlining digital processes, strengthening data security protocols and visual graphic design. Parenting with an independent entity like Discovery Health who are governed by the Medical Schemes Act could strengthen eLABS inclusion in the private sector and also include wearable devices interfacing with eLABS for patient-monitoring. Continued partnership with BMGF and the onboarding of Imperial College could greatly increase our access to diagnostic and other digital technology innovations for the continued growth of eLABS and ensure relevance. This suggested multi-partner approach will synergise and streamline collaborations and minimise duplication of efforts. As an academic institution, we depend on grant funding. Sponsors (USAID, CDC, and BMGF) have provided the backbone to ongoing innovation development and implementation, which we would like to continue. This also includes ongoing stakeholder engagements with in-country Ministries of Health and implementing partners.