A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
Mobile health (mHealth) applications may improve timely access to health services and
improve patient-provider communication, but the upfront costs of implementation may be
prohibitive, especially in resource-limited settings.
Methods
We measured the costs of developing and implementing an mHealth-facilitated, homebased
strategy for tuberculosis (TB) contact investigation in Kampala, Uganda, between
February 2014 and July 2017. We compared routine implementation involving community
health workers (CHWs) screening and referring household contacts to clinics for TB evaluation
to home-based HIV testing and sputum collection and transport with test results delivered
by automated short messaging services (SMS). We carried out key informant
interviews with CHWs and asked them to complete time-and-motion surveys. We estimated
program costs from the perspective of the Ugandan health system, using top-down and bottom-
up (components-based) approaches. We estimated total costs per contact investigated
and per TB-positive contact identified in 2018 US dollars, one and five years after program
implementation.
Results
The total top-down cost was $472,327, including $358,504 (76%) for program development
and $108,584 (24%) for program implementation. This corresponded to $320-$348 per
household contact investigated and $8,873-$9,652 per contact diagnosed with active TB over a 5-year period. CHW time was spent primarily evaluating household contacts who
returned to the clinic for evaluation (median 30 minutes per contact investigated, interquartile
range [IQR]: 30–70), collecting sputum samples (median 29 minutes, IQR: 25–30) and
offering HIV testing services (median 28 minutes, IQR: 17–43). Cost estimates were sensitive
to infrastructural capacity needs, program reach, and the epidemiological yield of contact
investigation.
Conclusion
Over 75% of all costs of the mHealth-facilitated TB contact investigation strategy were dedicated
to establishing mHealth infrastructure and capacity. Implementing the mHealth strategy
at scale and maintaining it over a longer time horizon could help decrease development
costs as a proportion of total costs.
Description
Keywords
Mobile health, Tuberculosis contact investigation, Low-income setting
Citation
Turimumahoro P, Tucker A, Gupta AJ, Tampi RP, Babirye D, Ochom E, et al. (2022) A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting. PLoS ONE 17(4): e0265033. https://doi. org/10.1371/journal.pone.0265033