ARMED - Antimicrobial Resistance Mapping & Early Detection

We propose a publicly accessible AMR surveillance dashboard enabled by real-time data analytics to map and track antimicrobial resistance in human populations and environments. This dashboard will serve as an early detector of disease outbreaks in 14 districts across the Indian state of Kerala by regularly monitoring medical caseloads, wastewater and air environments.

Dr. Swetavalli Raghavan, Professor of Practice, St. Joseph's University and Head of Innovation, Strategy & Government Affairs (India & South Asia), Royal Society of Chemistry

India, with its 1.4 billion population size, has one of the highest bacterial burdens in the world; consequently the use of antibiotics is also one of the largest. Unfortunately, not all of this use is appropriate or necessary, contributing to a serious multidrug resistance crisis in the country. Today, India is seen as a reservoir of extremely deadly bacterial pathogens. Comprehensive data is lacking on the scale of the crisis, types of resistance that are predominant and the geographic differences in resistance. Most of the surveillance data currently available are either historic or restricted to tertiary care centres, consequently rending it inadequate when it comes to guiding policy-decisions, medical resource and budgetary allotments or in chalking out treatment guidelines in real time. 

Our solution serves the following stakeholders:

1. Government : to make decisions related to policy, pricing and access to antimicrobials

2. Physicians: to access real time data on drug resistance, thereby facilitating a more rational choice of antibiotics and roll-out of robust stewardship programmes adapted to local context

3. Patients undergoing tests or procedures in a hospital: to have awareness/access to geographic maps on drug resistance, thereby by influencing their choice of treatment location

4. Researchers (working in the areas of One Health, AMR), Industry and Startups (working on Drugs & Diagnostics Development): to have access to real-time up-to-date data that feeds into their research and developmental activities.

At the very heart of our solution lies the principle of public service. We offer this solution as a free-to-use dashboard and a knowledge platform to improve public awareness on AMR and enable the public to make informed choices on their health and lifestyle.

Data on drug resistance are important (i) for patients undergoing tests or procedures in a hospital, awareness of drug resistance can influence choice of location, (ii) for physicians, real time data on drug resistance facilitate a more rational choice of antibiotics, and (iii) for policy decisions related to  pricing and access to antimicrobials. In India, data on resistance are mainly gleaned from publications by investigators studying resistance for research purposes. These data are both geographically and temporally restricted. The World Health Organisation has attempted to create a surveillance network through a software that allows hospitals to analyze and share their susceptibility data. Individual hospitals use the software but no network has come together. The lack of an administering agency appears to be the main problem. Moreover, the software has compatibility issues with automated systems, necessitating manual entry. 

Our solution addresses all these problems and involves a government department, the State Health Systems Resource Centre in Kerala, as the administrative agency to bring together a network of not just hospitals but also stakeholders from community. Moreover, our software is a simple-to-use system that automatically feeds into a central data repository. The output on the dashboard shall be comprehensive, anonymised & ready-to-use.

In the first phase, a pilot study involving 14 districts of Kerala, a state in south India will be taken up. From each district one each of a tertiary and secondary care hospital and two primary care hospitals will be enlisted. In addition, samples for susceptibility testing will be acquired from community and environment across 4 sites of study. Over a period of 18 months, we propose to complete the following: 

1. Build a software application for extraction and collection of data from automated testing systems and analyze resistance by organism, disease indication, type (community vs. hospital acquired), time period and antibiotic, as well as for data generated through sample testing.

2. Install, train and test database security (data anonymity) 

3. Monitor how often the platform is queried by participating hospitals 

4. Survey physicians for impact of data access on antibiotic prescribing practices

Third Year Plan/Target-

Make publicly available a real-time informative and predictive surveillance dashboard and scale up the operation in the State of Kerala to include more study sites and data points to improve accuracy of predictive outcomes. 

Leverage the success of this pilot to persuade other Indian states to setup similar surveillance systems. 

Our solution aims to create a publicly available predictive tool that assists stakeholders (government, research organisations, physicians and public) in making informed decisions. Our measures of success includes -

1. Volume of legislative or policy decisions and public guidelines issued on the basis of evidence generated by our solution, measured as citations.

2. Public acceptance and utility of our solution, measured as visits/views of the dashboard/webpage.

3. Changes effectuated within sites of study/data collection as a consequence of the evidence generated by our solution, measured as notifications/guidelines issued at institutional level.

We envisage the following barriers:

1. Financial - The bulk of funding for research activities undertaken in public interest in India comes from the central government. Since ICMR (a government agency) already has a national surveillance network, albeit an inadequate one (in terms of sample size, data sharing policy and transparency), it is unlikely that our project will find sufficient funds internally, even though we offer greater coverage of data and accessibility. 

We plan to overcome this barrier by persuading philanthropists and state-level governments to finance the scaling of our solution. 

2. Awareness gaps - The depth of understanding about AMR and extent of its impact on public health is as yet largely unknown, not only among general public but also among authorities. This often leads to apathy or lack of interest in participating.

We are already conducting awareness and sensitisation workshops for stakeholders across various sectors and geographies. We have thus far received positive responses from them in engaging with our project. 

India is still in its infancy when it comes to research in the areas antimicrobial resistance and One Health, but is most affected by the burden of AMR. To pilot and scale an ambitious solution nation-wide requires concerted effort, and unlimited resources, thereby making our solution capital-intensive. However, we, as a team, are committed to translating our solution into a freely accessible public tool and looking for funding that enables us to deliver public good. The Trinity Challenge in addition to offering the required funds, opens up a plethora of opportunities to learn and collaborate with leading academic and industry networks pioneering research and technology advancement in the areas of antimicrobial resistance and One Health, which we will greatly benefit from.

The expertise and breadth of organisations contributing to The Trinity Challenge represents the world’s best minds and most influential leaders from business, academia, and the social sector. We seek to collaborate with 

academic and industry partners who have the technical know-how and/or novel technologies that add accuracy and sensitivity to testing and characterising isolates of interest at the initial phase of the project. We would also be keen to partner with expertise on handling big data as we look to scale. Lastly, we wish to engage with partners who might utilise outcomes of our analytics or the repository of information we create to advance research in the field, or partners who may want to expand scope of our work to other geographic areas.