TIRAT-Ethiopia

Addis Ababa University

TIRAT-Ethiopia

TIRAT-Ethiopia: Data-driven solution combining modeling and PAD to detect SF antibiotics in the community

Addis Ababa, Ethiopia

ETH

Nonprofit

\Globally, the World Health Organization estimates that 1 in 10 medical products in low- and middle-income countries (LMICs) are substandard and falsified (SF), with antimicrobial drugs being among the most affected. This has devastating consequences: SF antimicrobials undermine public trust in healthcare systems, lead to prolonged illness or death, and drive the spread of antimicrobial resistance (AMR). Worldwide, nearly 170,000 childhood pneumonia deaths are caused by SF antibiotics annually. In Ethiopia, studies have shown that up to 20–30% of medicines are SF, especially antibiotics, due to weak supply chain controls, regulatory capacity gaps, and limited post-market surveillance (PMS). This problem is particularly severe in informal markets and under-resourced health systems, where stock visibility is low and quality testing infrastructure is limited or inaccessible. Yet regulatory authorities in LMICs often do not have the resources and tools to efficiently and effectively conduct PMS to remove SF antibiotics. Conducting laboratory testing of medicine quality is expensive, time consuming, and requires trained personnel and functional equipment that are typically not available. Moreover, testing is less effective when PMS approaches areas where SF medicines are less likely to be found. Therefore, inexpensive solutions to identify and test antibiotic quality in communities are needed.

Our solution “TIRAT-Ethiopia” means “Quality” in Amharic, which stands for “Technology for Integrated Resistance and Access Tracking”. Our solution combines modeling with low-cost Paper Analytical Devices (PADs) and risk-based post-market surveillance to identify SF products and control AMR. First, we use inventory data from pharmacies and health-facilities to map antimicrobial stock flows and identify areas that have higher likelihoods of SF medicines entering the supply chain. Using modeling and geospatial analysis, we will flag these hotspots to help regulators at the Ethiopian Food and Drug Authority (EFDA) focus surveillance and enforcement efforts. Second, we will introduce a simple technology called PADs that can be used by frontline trained health-workers in the field to check the quality of widely used antibiotics such as amoxicillin and ciprofloxacin. PADs are paper-based test cards on chromatography paper that will react with chemical contents of a drug and produce a unique color pattern, which can be visually compared to a reference guide to identify SF antibiotics. Together, the solution empowers health-workers and regulators with real-time, affordable tools to detect poor-quality antibiotics and act quickly to protect public health and combat AMR. The system is inexpensive, scalable, low-resource friendly, and designed for use in underserved communities.

Our solution, TIRAT-Ethiopia, serves low-income and underserved communities in Ethiopia, particularly those who rely on essential medicines including antimicrobials from the public sector, gray markets, and pharmacies with less regulatory enforcement. These populations are disproportionately affected by SF antimicrobials, due to limited regulatory oversight, poor stock visibility, and a lack of affordable drug quality testing methods at the community level. As a result, they face increased risks of treatment failures, prolonged illnesses, financial hardship, and exposure to drug-resistant infections. By introducing inventory modeling to identify high-risk areas and low-cost PADs for rapid field testing, we provide frontline health workers, pharmacies, and regulatory bodies with practical tools to detect and remove poor-quality antimicrobials from circulation. This improves treatment outcomes, reduces the burden of antimicrobial resistance, and restores trust in healthcare systems. Our solution is also designed to be participatory: we work closely with community pharmacies and local regulators to co-develop tools, ensure cultural relevance, and build capacity through training. Ultimately, the impact is more than technical, it is about strengthening regulatory authorities and empowering communities to protect themselves from unsafe medicines and creating a safer, more equitable pharmaceutical system for the people who need it most.