Abstract Globally, more than 90% of all snakebite envenomation (SBE) occur in low resource settings. This neglected tropical disease, affects 2.7 million people, with 81,000-138,000 deaths, and approximately 400,000 permanent disabilities annually. Antivenom is a safe, efficacious, time- dependent, and evidence-based treatment, but the availability and timely access to this standard of care is inadequate. It is critical to engage local communities to improve timely access in remote, low resource areas where most SBE morbidity occurs. This proposal will develop and evaluate an innovative multi-modal intervention to improve SBE care, including decentralized antivenom distribution among the existing community healthcare center (CHC) network in the Brazilian Amazon. This novel intervention will integrate (a) advanced geospatial artificial intelligence to create decentralized antivenom distribution models using existing CHCs that optimizes population coverage and time to reach care, (b) a cost-effectiveness evaluation model developed with key stakeholders, and (c) a culturally relevant SBE care package containing education, treatment guidelines, training on antivenom delivery and interfacility care coordination. Using the Consolidated Framework for Implementation Research, we will conduct a formative evaluation of this multi-modal intervention and prepare an implementation strategy for the Brazilian Amazon, as well as prepare to scale up to other low resource locations. Consequently, we will have a standardized approach to use advanced analytics to optimize healthcare delivery in low resource settings that can be used in other countries and with other healthcare interventions.

Project Narrative Snakebite envenoming (SBE) is a neglected tropical disease that affects 2.7 million people, mostly in low resource areas, with up to138,000 deaths, and approximately 400,000 permanent disabilities annually. Antivenom is a safe, efficacious, time-dependent, and evidence-based treatment, but the availability and timely access to this standard of care is inadequate, especially in low resource areas where SBE is more likely to occur. This proposal will develop and evaluate an innovative multi-modal intervention to improve SBE care, including decentralized antivenom distribution among the existing community healthcare network in the Brazilian Amazon.