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

我的手机钱包：支持乌干达农村地区获得结核病护理和药物依从性的干预措施

• 批准号: 10460519
• 负责人: Angella Musiimenta
• 金额: $ 15.74万
• 依托单位: MBARARA UNIVERSITY/SCIENCE/ TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-02 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10460519
• 关键词: Address; Adherence; Adoption; Adult; Behavioral; Behavioral Sciences; Car Phone; Caring; Client; Clinic; Clinical; Consumption; Country; Diagnosis; Economics; Ensure; Environment; Face; Financial Hardship; Financial Support; Focus Groups; Future; Geography; Grant; HIV; Health Services Accessibility; Health Technology; Hospital Referrals; Incentives; Incidence; Income; Individual; Infrastructure; Intervention; Interview; Low income; Madagascar; Malaria; Maternal Health Services; Measures; Monitor; Motivation; Newly Diagnosed; Notification; Outcome; Patient Recruitments; Patients; Persons; Pharmaceutical Preparations; Prevalence; Public Health; Randomized; Randomized Controlled Trials; Research; Research Personnel; Review Literature; Rural; Services; Social support; System; Technology; Testing; Time; Travel; Tuberculosis; Tuberculosis diagnosis; Uganda; acceptability and feasibility; arm; base; behavioral economics; cost; design; drug-sensitive; financial incentive; follow-up; improved; innovation; mHealth; medication compliance; mortality; novel; pilot test; public health priorities; real time monitoring; success; text messaging intervention; theories; transmission process; treatment adherence; treatment duration; tuberculosis treatment; usability

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).

联系PI（最后，第一，中间）：Musiimenta，Angella 项目摘要 重要性：乌干达面临着结核病的沉重负担，患病率为每10万人253人 发病率为每10万人201例。结核病药物治疗效果差， 个人，并增加其传输。有条件或无条件现金形式的财政奖励 转移已显示出改善结核病护理的希望，但该方法主要在 结核病不是公共卫生优先事项的国家，目前的方法需要昂贵的面对面治疗 交互.建议的干预：我的移动的钱包是一种新颖的行为和经济干预， 利用短信提醒服药依从性，并利用移动的货币方式提供运输 到诊所，并激励药物依从性。我们的总体假设是，我的移动的钱包将 克服目前制约结核病药物治疗的行为问题、关键的财务和动机问题 坚持。创新：据我们所知，我们的研究是第一个客观评估 衡量的依从性、短信提醒和基于行为经济学的激励措施（通过移动的提供 资金），以支持结核病药物治疗的依从性。方法：在R21目标1中，我们首先确定最佳设计 并开发“我的移动的钱包”作为支持结核病药物依从性的干预措施。以用户为中心 方法，我们将反复进行焦点小组讨论，最多30名结核病患者从结核病 Mbarara地区转诊医院（MRRH）。然后，我们评估初步的可行性和可接受性， 使用我的移动的钱包来支持结核病药物治疗，在R21 Aim 2中，基于40名新诊断为 活动性、药物敏感性结核MRRH。可行性将通过收到现金转账、收到短信、 遇到的技术问题。将使用系统可用性和访谈评估可接受性 基于技术接受与使用的统一理论。在R33 Aim 1中，我们进一步完善和调整了My 移动的钱包，然后试点测试它在10个结核病患者超过两个月的治疗，以确保最佳 功能.然后，我们评估改进的"我的移动的钱包“干预的大规模可行性、可接受性， 以及对结核病治疗依从性和临床结局的影响（R33目标2） 对162例肺结核患者进行为期6个月的随访。可行性和可接受性将按照所述进行评估 以上影响评估将基于电子监测的药物依从性（主要），以及 治疗完成率、门诊就诊率、治愈率和死亡率（次要）。研究者/环境： 我们的团队带来了移动的健康技术设计和采用以及行为科学方面的专业知识（Drs Musiimenta和Haberer）和行为经济学（Linnemayr博士）。未来发展方向：我的移动的钱包是 设计的基础设施需求有限，从而为真实的世界大规模实施创造了潜力， 可以在未来的多站点集群随机（R 01赠款）进行测试。

项目成果

Digital Adherence Technologies and Mobile Money Incentives for Management of Tuberculosis Medication Among People Living With Tuberculosis: Mixed Methods Formative Study.

• DOI: 10.2196/45301
• 发表时间: 2023-04-12
• 期刊: JMIR FORMATIVE RESEARCH
• 影响因子: 2.2
• 作者: Musiimenta, Angella;Tumuhimbise, Wilson;Atukunda, Esther;Mugaba, Aaron;Linnemayr, Sebastian;Haberer, Jessica
• 通讯作者: Haberer, Jessica

A review of mobile health interventions for public private mix in tuberculosis care.

• DOI: 10.1016/j.invent.2021.100417
• 发表时间: 2021-09
• 期刊: Internet interventions
• 作者: Tumuhimbise W;Musiimenta A
• 通讯作者: Musiimenta A

Barriers and Motivators of private hospitals' engagement in Tuberculosis care in Uganda.

• DOI: 10.1007/s43477-021-00030-3
• 发表时间: 2021-12
• 期刊: Global implementation research and applications
• 作者: Tumuhimbise W;Musiimenta A
• 通讯作者: Musiimenta A