A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting

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dc.contributor.authorTurimumahoro, Patricia
dc.contributor.authorTucker, Austin
dc.contributor.authorGupta, Amanda J.
dc.contributor.authorTampi, Radhika P.
dc.contributor.authorBabirye, Diana
dc.contributor.authorOchom, Emmanuel
dc.contributor.authorGgita, Joseph M.
dc.contributor.authorAyakaka, Irene
dc.contributor.authorSohn, Hojoon
dc.contributor.authorKatamba, Achilles
dc.contributor.authorDowdy, David
dc.contributor.authorDavis, J. Lucian
dc.date.accessioned2023-01-17T18:12:03Z
dc.date.available2023-01-17T18:12:03Z
dc.date.issued2022
dc.description.abstractMobile 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.en_US
dc.identifier.citationTurimumahoro 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.0265033en_US
dc.identifier.urihttps://doi. org/10.1371/journal.pone.0265033
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/6985
dc.language.isoenen_US
dc.publisherPLoS ONEen_US
dc.subjectMobile healthen_US
dc.subjectTuberculosis contact investigationen_US
dc.subjectLow-income settingen_US
dc.titleA cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income settingen_US
dc.typeArticleen_US
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