UNITY-AMR: Utilizing Networked Insights To Yield AMR Solutions

We sell a portfolio of affordable antibiotics, engaging with 72,000 pharmacists/doctors through 400 distributors, impacting millions of health seekers in rural India. We propose to launch digital data collection and education tools for pharmacists/doctors, and antibiotic users, generating community-based insights and action on antibiotic usage, informing strategies to address AMR.

Team Lead for this solution is Vivek Shankar Verma, CEO of reach52 India (https://www.linkedin.com/in/vervivek/)

The burden of antimicrobial resistance (AMR) in India is staggering, with significant implications for public health and the economy. India experiences more than 1 million deaths annually associated with AMR. Globally, India ranks 145th for age-standardized AMR-associated mortality rate, indicating a larger burden than more than 2/3rds of other countries.

Contributing to this problem is the overuse and misuse of antibiotics, with India experiencing a 65% increase in antibiotic consumption in India between 2000 and 2015. Despite efforts to improve surveillance, particularly in rural areas where healthcare infrastructure is limited, significant gaps remain.

The economic toll of AMR is substantial, with modeling estimating that by 2050, India could lose US$1.2 trillion in economic output due to AMR. Additionally, India's status as one of the largest consumers of antibiotics in agriculture exacerbates the spread of resistant bacteria in the environment and food chain.

These findings underscore the urgent need for comprehensive strategies to address AMR in India, encompassing improved surveillance and public awareness campaigns.

Our solution serves three distinct groups: antibiotic users in rural communities; the healthcare providers serving them; and the larger global health research and advocacy community, aiming to address their distinct needs concerning antibiotic usage and AMR.

Antibiotic users lack access to reliable information on proper usage and may inadvertently contribute to AMR through overuse or misuse. This may also apply to healthcare providers, who in addition to low awareness of AMR, also experience a profit motive to sell antibiotics. We provide educational resources and tools for reporting usage and associated symptoms, empowering users to make informed decisions and promote responsible antibiotic use.

The larger research and advocacy community faces challenges in accessing comprehensive data on antibiotic usage, AMR prevalence, and user/provider knowledge, attitudes and practices on a very local level. Our platform enables data collection and analysis, supporting informed decision-making and targeted interventions to combat AMR.

In developing this data collection, analyses, and educational platform, we are proposing to adopt a user-centered design approach, incorporating participatory principles. To ensure we are answering the right questions and providing meaningful information, we intend to engage various stakeholders through workshops, community meetings, and user testing sessions, soliciting feedback at every stage of development. 

Our solution will provide a public good in the form of an open-access knowledge repository containing data, insights, best practices, and actionable recommendations for combating antimicrobial resistance (AMR) in underserved rural communities. This repository will compile data collected through our digital platform, along with insights derived from the impact of our educational efforts.

Accessible to all stakeholders, including policymakers, healthcare providers, researchers, and the general public, the knowledge repository will serve as a valuable resource for understanding the drivers of AMR and implementing evidence-based interventions. By sharing our findings and experiences transparently, we aim to foster collaboration, innovation, and collective action towards mitigating the threat of AMR globally.

Furthermore, we will ensure that the knowledge repository adheres to fair, reasonable, and non-discriminatory terms, making it accessible to stakeholders worldwide. Through this initiative, we contribute to the public good by disseminating knowledge and empowering communities to combat AMR effectively, ultimately benefiting the well-being of populations globally.

We expect the proposed works to improve knowledge, attitudes, and practices around the responsible and evidence-based dispensing and consumption of antibiotics among under resourced/underserved pharmacists/doctors/populations in rural India.

Abridged activities:

• Conduct participatory needs assessment and asset mapping exercise to inform program design
• Design data collection tools
• Design education and gamification curricula
• Develop digital assets, including front-end portal and back-end data analyses tools and dashboards
• Translate materials into local languages
• Pilot test and iterate
• Promote and launch initiative through partnered 30k (hoping to scale much larger!) pharmacies/doctors/community health workers
• Collect and analyze citizen-submitted data
• Make available real-time data for researchers and public health officials
• Measure longitudinal changes to KAP, based on exposure to educational resources
• Produce research findings (in partnership) and perform knowledge translation and dissemination activities

Outputs (quantified targets TBD):

• n millions of individual survey responses collected
• n millions of antibiotic consumers educated
• n tens of thousands of pharmacists/doctors educated
• n tens of thousands of CHW-led health events facilitated
• Research deliverables produced and disseminated

Outcomes:

Improved antibiotic usage insights, enhanced data analysis, increased awareness, empowered communities, and positive public health impact are anticipated outcomes, contributing to a comprehensive approach to combating antimicrobial resistance in rural settings.

In the shorter term, we aim to develop deeper relationships with government and AMR researchers in India, to improve data collection methods; while also scaling up to additional pharmacies as we continue to expand our on-the-ground footprint.

Over the next 3-year period, we plan to scale our impact by expanding our platform's reach to specific regions in Kenya, leveraging reach52’s existing investments there, including partnerships with local healthcare organizations and government agencies. We will focus on enhancing community engagement and data collection efforts to address specific challenges related to antimicrobial resistance in these areas.

Looking further ahead, we aim to further scale our impact by extending our platform's reach to other sub-Saharan African (SSA) countries facing similar challenges with antimicrobial resistance. By collaborating with regional stakeholders and adapting our solution to local contexts, we will empower communities across SSA to combat antimicrobial resistance effectively. Additionally, we will invest in capacity building and training programs to ensure sustainability and long-term impact. This will allow us to build a truly global community-based AMR data collection platform focusing on our relationships with local health seekers and service providers. 

We measure success against our impact goals through a combination of quantitative and qualitative indicators, including:

• Quantity of responses received: # of responses, by antibiotic user and healthcare provider
• Diversity of respondents: % of respondents from lower-quartile income; from lower casts; from ethnic/linguistic minorities; from other traditionally marginalized communities
• User engagement rate: average time spent on educational and informational areas of the platform
• Number of individual touchpoints: # of CHW-led AMR community health events facilitated; # of participating pharmacies/doctors
• Reduction in antibiotic misuse: % decrease in inappropriate antibiotic prescriptions or usage among antibiotic users, as measured through data collected via our platform

These quantitative measures will be augmented with rich qualitative data from key informant leaders from the field through focus group discussions and semi-structured interviews. 

There are regulatory considerations that must be addressed when making changes to medicine packaging or adding package inserts. Any delays in approval could necessitate us to adapt aspects of our strategy to promote our digital platform to antibiotic consumers.

There are also concerns about the ability to equitably reach bottom-of-the-pyramid health seekers through digitally-centered channels. Although our solution includes an extremely comprehensive offline/non-digital component, the bulk of data collection efforts still rely on self-reported data. In the past, we have relied on CHW-led data collection from beneficiaries. If we are not achieving equitable engagement, we might consider pivoting to include a CHW-led data collection component, so that we can engage all individuals, regardless of their tech literacy levels.

Another potential barrier is the need for sustained funding to support our scaling efforts over the next three years. To address this, we will explore diverse funding sources, including grants, partnerships, and impact investment opportunities. Additionally, we will pursue cost-sharing arrangements and revenue-generating strategies to ensure the long-term sustainability of our initiative. 

We only recently accelerated our essential medicines (including antibiotic) access  operations in late 2023 via a partner’s business being transitioned to reach52. We feel we are much better positioned to generate actionable, community-based data, insights, and impact from these operations than the previous operators. There are tremendous opportunities that we can leverage through this large distribution network and BOP consumer base.

We are also deeply committed to being responsible antimicrobial stewards. We are acutely aware of the impact that AMR is having on the health and economic well-being of our country. However, we are a relatively small organization, relative to the size of global pharma firms, or major generic producers.

For these reasons, we are extremely enthusiastic about the potential to collaborate with the expertise and resources of the Trinity Challenge, to help reach52 achieve our full impact potential and support our goals of delivering accessible, equitable healthcare to the 52% of the world who face access barriers. 

We have a network of 400 distributors active, and believe these could be key partners as any additional materials could be supplied via them to other pharmacies and doctors, and with other products. The government and local Health and Wellness Centres can also be key partners, once the method is proven. 

reach52 is a collaborative, partnership-driven organization. We enthusiastically welcome the broad engagement, supports and inputs of the Solve/Trinity community in bringing these proposed actions to fruition.