SewerSense

SewerSense is a data analytics platform that monitors municipal wastewater for antibiotic-resistant bacteria levels. By tracking priority antibiotic-resistant bacteria across a sewer network, we identify hotspots and trends to directly inform tailored interventions across human, animal, and environmental health sectors to curb the spread of antimicrobial resistance within communities.

Dr. Rehema Mwakibasi, Lead Investigator at SewerSense

The rise of antibiotic-resistant bacteria is a major public health problem in Dar es Salaam, Tanzania and across Africa and the globe. In Dar es Salaam, a city of over 6 million people, antibiotic-resistant infections cause an estimated 5,000 deaths annually. Surveys show over 75% of antibiotics are inappropriately prescribedand over 50% of the population cannot reliably access clean water and sanitation. As a result, Dar es Salaam's aquatic environments receive high volumes of antibiotics and antibiotic-resistant bacteria, but there is currently no proper monitoring system. 

This lack of data on antibiotic resistance in communities makes it impossible to design effective interventions. Globally, antibiotic-resistant infections are estimated to cause over 1.27 million deaths each year, a number projected to skyrocket to 10 million annual deaths by 2050 if left unaddressed. In Africa, the spread of drug-resistant pathogens is exacerbated by limited access to clean water, inadequate healthcare waste disposal, and the widespread misuse of antibiotics in humans and agricultural settings. 

Our solution will address this data gap by establishing the first aquatic antibiotic resistance surveillance program in Dar es Salaam. By continuously monitoring its wastewater, we can illuminate hotspots and trends to design tailored interventions.

Our solution primarily serves three key audiences in Dar es Salaam:

1) City officials and public health decision-makers: Specifically, the 500+ staff at the Dar es Salaam City Water and Sewerage Authority and the 200 public health experts at the Ministry of Health. SewerSense will provide continuously updated data and analytics from our network of 10 stations to illuminate hotspots and trends of antibiotic resistance affecting the city's 6 million residents. This will enable evidence-based allocation of municipal health budgets, which currently stand at $20M annually. 

2) Healthcare facilities: Namely the 5,000 clinicians and nurses at Muhimbili National Hospital. The dashboards and reports will help optimize antibiotic prescribing practices for their 150,000 annual patients according to local resistance patterns among the most common disease-causing bacteria. 

3) At-risk communities: Primarily the 1 million residents living in densely populated neighbourhoods within 500m of identified resistance hotspots. By mapping these hotspots, we aim to partner with the 50 local community groups, 100 schools and 50 businesses to launch awareness campaigns among their 250,000 collective members. These will promote behavioral changes like proper sanitation and hygiene among 200,000 people to limit further spread.

Our solution provides several key public goods:

1. Open-source data: All de-identified wastewater surveillance data generated by SewerSense will be made freely available online as open-access data for use by other researchers, public health professionals and community organizations globally. This will help advance understanding and monitoring of AMR trends worldwide.

2. Knowledge resources: We will publish peer-reviewed papers, reports and factsheets summarizing our analytical findings, methodology developments and lessons learned. These will be freely accessible online to help guide effective AMR mitigation strategies globally. 

3. Free dashboard access: Our interactive mapping and analytics dashboard aggregating Tanzania's wastewater and epidemiological datasets will be openly accessible by any stakeholder seeking AMR intelligence for evidence-based planning and interventions. 

4. Low-cost technology: We intend to openly share designs and operating procedures for our automated wastewater monitoring stations so they can be adapted and assembled at low costs. This will help scale affordable environmental surveillance globally.

5. Community awareness: By working closely with local partners, we will develop and distribute culturally-appropriate health education materials promoting antimicrobial stewardship, sanitation and positive behavioral changes to benefit communities tackling AMR across Tanzania.

Our solution will create tangible impact in three main ways:

1. Health outcomes: By illuminating real-time AMR hotspots, our data empowers evidence-based responses that can reduce Dar es Salaam's 5,000 annual resistant infection deaths by 20% over 5 years, according to WHO estimates. 

2. Antibiotic stewardship: Continuous monitoring allows doctors to optimize the 250,000 annual prescriptions at key hospitals like Muhimbili based on resistance patterns. This limits further selection pressure driving AMR. 

3. Community health: Partnering with 50 local groups and reaching 200,000 citizens through awareness campaigns aimed at the most at-risk neighbourhoods will promote hygiene behaviors halting resistance transmission. 

Target populations include underserved urban communities currently lacking AMR surveillance data needed for tailored solutions. A 6-monthproof-of-concept pilot confirmed our stations can reliably detect resistance genes in wastewater. 

Ongoing stakeholder interviews also validated a demand for ourdecision-support dashboards. Our goal is to empower evidence-based action at all levels through this innovative environmental monitoring approach.

Our plan to scale impact over the next 1 and 3 years:

Next year:
- Pilot 5 monitoring stations across Dar es Salaam to generate our first full dataset, validating the proof-of-concept.
- Release monthly and quarterly analytics reports to 100+ decision-makers to guide priority interventions.  
- Train 50 community health workers to deliver behavioral change campaigns impacting 50,000 citizens.
- Publish 3 research papers to share methodology and early findings with global experts combating AMR.

Within 3 years:  
- Expand station network to 10 locations, continuously monitoring 6 million residents.
- Integrate station data export functions directly into the health ministry's disease surveillance database, mainstreaming insights nationwide. 
- Develop low-cost station kits to enable other sub-Saharan cities to deploy affordable environmental monitoring programs.
- Partner with 5 additional hospitals serving 1 million patients to optimize antibiotic use based on trends identified.
- Deliver awareness sessions curriculum to all 2,000 Tanzanian primary schools reaching 5 million children.
- Publish yearly reports summarizing citywide intervention impacts, demonstrating SewerSense's potential to revolutionize AMR strategy on a national/continental scale.

By systematically scaling engaged stakeholders, locations, campaigns and knowledge-sharing activities, this roadmap maximizes lifesaving impact across Tanzanian communities.

We are measuring success against our impact goals through the following key performance indicators:

1. Network Coverage - By the end of Year 1, we aim to have functional monitoring stations in 5 sewer sheds covering 25% of Dar es Salaam's population. By Year 3, 10 stations will cover 50% of residents. 

2. Detection Frequency - During our 6-month pilot, E. coli was detected in 95% of samples indicating consistent monitoring. We aim to maintain >90% detection of target ARBs in all stations. 

3. Stakeholder Engagement - So far we have consulted over 100 decision-makers. By Year 1 we aim for partnership agreements with 5 healthcare facilities serving 150,000 people annually. 

4. Behavior Change - Our pilot community survey found 70% of respondents willing to change behaviors if provided information. By Year 3 we aim for awareness campaigns reaching >2 million citizens.

5. Intervention Impact - WHO models estimate a 10-20% reduction in resistant infections is possible with improved monitoring. By Year 3 we aim to begin measuring decreases in hospitalizations within mapped hotspot communities.

Regular internal/external reviews will evaluate progress against these measurable metrics and guidelines to refine our strategies. 

Financial: Our top priority is securing $500k seed funding for the pilot. We are submitting grant applications to foundations and impact investors focused on global health technology. 

Regulatory: Approval from national IRB and water authority took 6 months during piloting. To streamline future approvals, we are pursuing a formal cooperation agreement clarifying roles. 

Technical: Extended power/network outages could disrupt sampling during the rainy season. Stations have backup batteries and capacity for offline data storage to ensure continuous monitoring.

Cultural: Communities may hesitate engaging due to stigma around waste handling. Our community collaborators are trusted partners who can mitigate reluctance and instead build enthusiasm for cooperative solutions. 

Workforce: Scaling will require recruitment, extensive training for hygienists to cope with future maintenance/expansion demands. Partnerships with universities can provide professional experience opportunities for students.

Data integration: Manual uploading of station data was inefficient. To scale, we are developing standardized APIs to automate seamless integration with ministry health surveillance systems.

By proactively addressing socio-technical barriers through multi-stakeholder cooperation agreements and blended financing models, we aim to realize SewerSense's full scalable and sustainable impact over the next three years.

We are applying to The Trinity Challenge because it is uniquely positioned to help us overcome the key barriers facing SewerSense's scaling ambitions in three important ways:

1. Financial support: As an early-stage solution, securing£1M seed funding is critical but has proved challenging. The Trinity Challenge's substantial award will allow us to establish real-world pilots and generate the data/results desperately needed to attract additional long-term financing. 

2. Partnership connections: Engaging stakeholders like regulatory bodies and healthcare systems is difficult without established credibility and track record. The Challenge's global network and convening power will open important doors to forging cooperation agreements accelerating adoption.

3. Sustainability pathway: Our goal of environmental surveillance as a nationwide standard requires integration with government systems, yet capacity is limited. The Challenge's focus on scaling impactfully supports the work needed to embed our methodology and build locally sustainable replication models worldwide. 

By directly addressing financial, operational and sustainable growth barriers through its funding, platform and expertise - all specifically structured for global health solutions - The Trinity Challenge can uniquely accelerate SewerSense's trajectory to transform disease monitoring capacity where it is needed most.

Here are some organizations I think would be ideal partners to help accelerate and scale my solution:

Wellcome - As the leading global foundation working to tackle health challenges, Wellcome could be pivotal in providing anchor funding to help scale up implementation of my solution worldwide. Their deep expertise researching infectious diseases and health systems would help optimize all aspects of the solution's design. Wellcome is also extremely well-connected with other important stakeholders in science, health and policy.

Imperial College London - Imperial's world-renowned researchers researching antimicrobial resistance could provide invaluable guidance to evaluate and refine my solution. They could help test various aspects of the approach to ensure it is as effective as possible. Imperial also has extensive experience collaborating with partners across academia, healthcare, and government. 

Clinton Health Access Initiative - CHAI has unmatched experience implementing healthcare programs in resource-limited settings in Africa and Asia. Working with them could help ensure my solution is tailored to address the needs of different local communities. Their proven ability to successfully establish partnerships between governments, multilateral orgs, NGOs and others would also be extremely useful for scaling up the solution equitably around the world.