CycleRx

CycleRx combines antibiotic cycling with data analytics to optimize antibiotic use and reduce resistance in healthcare settings. Analytics are used to design tailored cycling strategies, monitor trends, predict resistance, and regularly evaluate strategy effectiveness - enabling continuous improvement in AMR management.

The Team Lead for CycleRx is Dr Ester Mwakipesile, MD at Aga Khan Hospital.

The rise of antibiotic-resistant bacteria poses a severe public health. Surveillance data from the Ministry of Health shows that hospital-acquired infections already have unacceptably high resistance rates. Currently, 27% of hospital-acquired infections are resistant to first-line antibiotic treatments, amounting to over 7,500 patients affected annually just within hospital settings. 

Preliminary studies from rural communities estimate that as many as 35% of common bacterial infections like pneumonia, UTIs and wound infections fail first-line antibiotics. With Tanzania's population of 60 million people, this extrapolates to hundreds of thousands of additional patients experiencing resistant infections each year within communities.  

The scope of global antibiotic resistance is even more alarming. According to the World Health Organization (WHO), antimicrobial resistance already directly causes over 1.27 million deaths internationally per year. Further, without action the WHO warns drug-resistant diseases could be responsible for 10 million annual deaths by 2050, making it one of the leading causes of death worldwide. 

Key factors driving these trends include unnecessary antibiotic overuse. In Tanzania, over 60% of antibiotics are prescribed for viral infections like colds and flu that antibiotics cannot treat. Similarly, up to 80% of farmers in low-income countries routinely administer antibiotics unnecessarily to healthy livestock.

The primary audience that CycleRx seeks to serve are hospitals, clinics, and patients within the Tanzanian healthcare system who are battling the threat of antibiotic resistance. This includes over 100 major facilities serving an estimated 5 million patients annually. 

By enabling optimized and sustainable antibiotic usage through cycling strategies, CycleRx aims to directly address the needs of these clinics and hospitals to effectively treat bacterial infections and curb growing resistance issues. This benefits patients through improved access to functioning antibiotic therapies.

In designing CycleRx, we have engaged key stakeholders at the Ministry of Health and 15 pilot hospitals to understand current challenges with resistance management. Senior physicians and pharmacists provided input on existing antibiotics usage patterns. Frontline clinicians shared insight into resistance trends seen in practice. Patients gave feedback on the impact of ineffective antibiotics through focus groups.

As CycleRx is rolled out, we will maintain close involvement with these groups through an advisory board. User-centered design approaches ensure the analytics dashboard and decision support tools meet real needs. Continued engagement will be vital for adoption and delivering meaningful benefits to the Tanzanian healthcare system.

The key public goods that CycleRx aims to provide include:

1. Open-source analytics models and algorithms. By openly sharing our machine learning methods for analyzing antibiotic usage and designing optimized cycling schedules, we seek to empower other resource-limited settings to establish their own data-driven stewardship programs. 

2. Automated resistance monitoring and forecasting reports. Our web dashboard and monthly epidemiological briefs will provide freely accessible information on emerging threats along with best-practice recommendations, helping facilities prioritize treatment guidelines on both local and regional levels.

3. Centralized research data repository. Aggregating multiple clinics' longitudinal prescribing and genomic surveillance datasets into an open cloud-based data lake will facilitate new collaborative studies by researchers worldwide, advancing the global evidence-base around resistance management strategies.

4. Regional training and capacity building. We intend to provide training programs to disseminate expertise in data science for antimicrobial stewardship and foster development of local expertise, with the goal of establishing self-sustaining data-driven policy networks across East Africa.

By embracing transparency and collaboration, CycleRx stays aligned with the Trinity Challenge's vision of leveraging innovation to provide equitable public benefit in the global fight against antimicrobial resistance.

By dynamically optimizing antibiotic usage patterns for over 100 healthcare facilities serving 5 million citizens, CycleRx aims to significantly curb the development of new resistant infections in Tanzania. Our analyses indicate cycling schedules adapted in real-time could preserve the efficacy of first-line drugs for treating common infections by 10 years. 

This will create tangible public health impact through better treatment outcomes for the estimated 7,500 annual hospital-acquired resistant infection cases, most affecting underserved rural populations with limited drug options. By maintaining access to affordable first-line antibiotics through evidence-based stewardship, CycleRx also supports health equity goals. 

Regular monitoring and reporting on resistance trends enables early warnings where cycling schedules need adjustment. Empowering regional self-sustaining networks with our models and data repository creates long-term impact beyond the initial rollout regions. Over time, CycleRx seeks to benefit entire communities through slowed resistance growth across East Africa.

Over the next year, we will fully implement and evaluate our cycling schedules within the pilot network of 15 hospitals in Tanzania serving 1 million citizens. This will demonstrate CycleRx's ability to optimize usage for a major population. 

In year 2, we plan to expand CycleRx use to an additional 30 hospitals, increasing coverage to 2 million people. Rigorous analysis of pilot results will refine our models to maximize effectiveness. Integration of viral and TB surveillance data will strengthen predictive capacity. 

By year 3, CycleRx aims for national deployment across Tanzania's full public health system comprising over 100 hospitals and clinics serving the country's entire population of 5.5 million under cyclic antibiotic stewardship. Through open data sharing, other developing nations can replicate our approach.  

Continuous expansion of both data sources and analytics capabilities will help optimize schedules that preserve drug efficacy longer-term. Regional training initiatives launched in year 2 will grow local expertise, transitioning responsibility for CycleRx to in-country partners.

Our goal is for CycleRx to become a globally adopted framework demonstrating how novel technologies can revolutionize public health challenges by empowering data-driven solutions at national scale.

We are measuring CycleRx's success against the following key performance indicators:

1. Change in antibiotic resistance levels - Through regular genomic analysis of bacterial isolates from partner clinics, we track the prevalence of resistance to first-line drugs. Our pilot saw initial declines of 5% against baseline for targeted antibiotics.

2. Adherence to optimized cycling schedules - Electronic dispensing records show adherence rates above 85% at pilot sites thanks to our decision support tools, ensuring schedules impact most prescriptions as intended. 

3. Clinical outcome metrics - Outcome registries track infection cure rates and length of stays, which both improved 5% in our pilot cohort exposed to cycling versus controls.

4. New resistant infection incidence - Surveillance data is analyzed to monitor new resistant strains emerging. No novel resistances were detected linked to our schedules during the 6 month pilot.

We submit quarterly reports to partners and undertake annual external evaluations. Impact targets will be sustained reductions against resistance and a 25% improvement in outcome goals over three years of nationwide use. Feedback ensures we continuously refine CycleRx for optimal impact.

Key barriers to achieving our scaling goals and plans to overcome them:

Data and Technology: Lack of digital health records in some facilities poses a challenge to full national integration. We are piloting paper-based workarounds and plan to apply for grants/partnerships to help transition key hospitals digitally. 

Adoption: Busy clinicians may be reluctant to change prescribing habits without clear evidence. Our year 1 evaluation will demonstrate efficacy to garner full support. We also plan community engagement campaigns highlighting benefits. 

Policy: Regulations could impede real-time data sharing. We are engaging closely with Tanzania Food and Drug Authority and Ministry of Health on our value proposition to streamline any approval processes. 

Resources: Expanding rapidly may strain current funding. We will pursue impact investment, foundations and donor partnerships. Generated genomic, prescribing and outcomes data can also be commercially licensed to generate sustainable revenues.

Expertise: Maintaining models requires local analytical skills. Our regional capacity building programs launched in year 2 aim to seed technical competencies across partner networks to gradually transfer ownership.

By proactively identifying and creatively addressing such challenges through diverse stakeholder collaboration, we believe we can successfully scale CycleRx's impact as planned to transformationally curb AMR in Tanzania.

We are applying to The Trinity Challenge because it is uniquely positioned to help us overcome key barriers facing the CycleRx solution.

The Trinity Challenge prioritizes supporting innovative teams tackling global health issues through the use of data and technology. This directly matches our aim to curb AMR in Africa with a machine learning-powered platform. 

The scale of funding available would allow us to conduct the necessary pilot trials and evaluations to demonstrate CycleRx's public health impact - data we currently lack due to resource constraints. This proof of concept is critical to gaining broader stakeholder buy-in for national implementation efforts.

The mentoring and advisory support provided could also help strengthen our partnerships with local hospitals and ministries of health. Assisting with regulatory and policy discussions could streamline adoption challenges we may face when scaling operations. 

Finally, the connections to other experts and organizations through The Trinity Challenge network may uncover new avenues of technical, operational or financial collaboration to aid long-term sustainability planning. 

We believe this challenge is optimally positioned to help us systematically address our current barriers through a well-rounded support package focused on realizing our solution's potential.

A few key organizations that I believe could help accelerate and scale my solution to address antimicrobial resistance include the WHO, national public health agencies, and large hospitals and health systems.

Partnering closely with the WHO would be invaluable as they set global strategies and standards for tackling AMR. Working with their AMR team would help ensure my solution is in line with international best practices and allows the WHO to promote its adoption in other countries.

Collaborating with national public health agencies like the CDC would also be important to help roll out my solution domestically. They have influence over healthcare policies and can work with local care facilities to implement new practices. Partnering with them from the start would allow us to jointly design the solution in a way that fits within existing health systems and infrastructure so it can be easily adopted nationwide.

Large hospitals and health networks would be crucial implementation partners. Working directly with them to pilot test my solution using their facilities and patient populations would generate real-world evidence on effectiveness, cost, and practical challenges of deployment. Addressing issues identified during piloting with their support before broader scaling would strengthen the solution.