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A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting
INTRODUCTION: 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 implementi...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8975098/ https://www.ncbi.nlm.nih.gov/pubmed/35363783 http://dx.doi.org/10.1371/journal.pone.0265033 |
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author | Turimumahoro, Patricia Tucker, Austin Gupta, Amanda J. Tampi, Radhika P. Babirye, Diana Ochom, Emmanuel Ggita, Joseph M. Ayakaka, Irene Sohn, Hojoon Katamba, Achilles Dowdy, David Davis, J. Lucian |
author_facet | Turimumahoro, Patricia Tucker, Austin Gupta, Amanda J. Tampi, Radhika P. Babirye, Diana Ochom, Emmanuel Ggita, Joseph M. Ayakaka, Irene Sohn, Hojoon Katamba, Achilles Dowdy, David Davis, J. Lucian |
author_sort | Turimumahoro, Patricia |
collection | PubMed |
description | INTRODUCTION: 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, home-based 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. |
format | Online Article Text |
id | pubmed-8975098 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-89750982022-04-02 A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting Turimumahoro, Patricia Tucker, Austin Gupta, Amanda J. Tampi, Radhika P. Babirye, Diana Ochom, Emmanuel Ggita, Joseph M. Ayakaka, Irene Sohn, Hojoon Katamba, Achilles Dowdy, David Davis, J. Lucian PLoS One Research Article INTRODUCTION: 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, home-based 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. Public Library of Science 2022-04-01 /pmc/articles/PMC8975098/ /pubmed/35363783 http://dx.doi.org/10.1371/journal.pone.0265033 Text en © 2022 Turimumahoro et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Turimumahoro, Patricia Tucker, Austin Gupta, Amanda J. Tampi, Radhika P. Babirye, Diana Ochom, Emmanuel Ggita, Joseph M. Ayakaka, Irene Sohn, Hojoon Katamba, Achilles Dowdy, David Davis, J. Lucian A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting |
title | A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting |
title_full | A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting |
title_fullStr | A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting |
title_full_unstemmed | A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting |
title_short | A cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting |
title_sort | cost analysis of implementing mobile health facilitated tuberculosis contact investigation in a low-income setting |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8975098/ https://www.ncbi.nlm.nih.gov/pubmed/35363783 http://dx.doi.org/10.1371/journal.pone.0265033 |
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