My Mobile Wallet: An Intervention to Support Access to Tuberculosis Care and Medication Adherence in Rural Uganda

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Contact PI (Last, First, Middle): Musiimenta, Angella PROJECT SUMMARY Significance: Uganda faces a high burden of tuberculosis (TB) with a prevalence rate of 253 per 100,000 people and an incidence rate of 201 per 100,000 people. Poor TB medication constrain treatment success for the individual and increase its transmission. Financial incentives in form of conditional or unconditional cash transfers have shown promise for improving TB care but the approach has mainly been implemented in countries where TB is not a public health priority, and current approaches require costly face-to-face interactions. Proposed intervention: My Mobile Wallet is a novel behavioral and economic intervention that utilizes SMS texts to remind medication adherence and utilize mobile money approaches to provide transport to the clinic and incentivize medication adherence. Our overall hypothesis is that My Mobile Wallet will overcome behavioral issues, critical financial and motivational issues that currently constrain TB medication adherence. Innovation: To our knowledge, our study is the first to assess the combination of an objectively measured adherence, SMS reminders, and behavioral economics-based incentives (delivered via mobile money) to support TB medication adherence. Approach: In R21 Aim 1, we first determine the optimal design and develop My Mobile Wallet as an intervention to support TB medication adherence. Using user-centered approaches, we will iteratively conduct focus group discussions with up to 30 TB patients recruited from the TB clinic in Mbarara Regional Referral Hospital (MRRH). We then assess the initial feasibility and acceptability of using My Mobile Wallet to support TB medication, in R21 Aim 2 based on 40 adults with new diagnoses of active, drug-sensitive TB MRRH. Feasibility will be assessed by receipt of cash transfers, SMS texts received, and technical problems encountered. Acceptability will be assessed using system usability and interviews based on the unified theory of acceptance and use of technology. In R33 Aim 1, we further refine and adapt My Mobile Wallet, and then pilot test it in 10 TB patients over two months of treatment to ensure optimal functionality. We then assess the refined My Mobile Wallet intervention for large-scale feasibility, acceptability, and impact on TB treatment adherence and clinical outcomes (in R33 Aim 2) through a randomized control trial composed of 162 TB patients followed for 6 months. Feasibility and acceptability will be assessed as described above. Impact assessment will be based on electronically monitored medication adherence (primary), as well as treatment completion, clinic attendance, cure rates, and mortality (secondary). Investigators/environment: Our team brings expertise in mobile health technology design and adoption, and behavioral science (Drs Musiimenta and Haberer), and behavioral economics (Dr. Linnemayr). Future directions: My Mobile Wallet is designed with limited infrastructure needs, thus creating potential for real world implementation at scale that can be tested in a future multisite cluster randomized (R01 grant).