Strengthening the continuity of HIV care in Tanzania with economic support

摘要 经济激励是一种基于证据的干预措施，旨在提高人们对有益健康行为的参与度 并为许多优先卫生问题提供服务。我们的团队广泛研究了金融服务的好处 对坦桑尼亚艾滋病毒携带者的奖励，包括通过正在进行的Rudi Kundini，Pamoja Kundini (R01MH125746)研究。我们团队和其他人的研究表明，经济激励会增加艾滋病毒 测试，加强与护理的联系，并加强治疗依从性。然而，尽管有这些证据，几乎没有财务上的 针对撒哈拉以南非洲的艾滋病毒和其他紧急健康威胁，已经扩大了激励计划的规模。其中一个原因 因为这个‘知识’的差距是用于实施激励计划的简化、自动化和安全的软件 尚待开发、评估和共享。 为了满足这一需求，通过与坦桑尼亚卫生部和坦桑尼亚技术 Rasello公司，我们开发了一个创新的、可接受的、可靠的和可伸缩的软件(“Rasello mHealth 系统“)，以使奖励分配自动化。该软件通过移动货币安全地发送激励措施， 通过生物识别监控艾滋病毒护理，发送短信访问和实验室检测提醒，并集成 通过应用程序编程接口(API)与合作伙伴数据库连接。广泛的利益相关者测试已经 允许软件的迭代改进，以无缝地整合到临床工作流程中。该软件是 在父R01(R01MH125746)中使用，但它的设计不是最好地与软件工程保持一致 实践、FAIR4RS原则或开放科学原则，这将限制其影响。鉴于这是 R01MH125746获奖时没有预料到的是，Rasello mHealth系统是本申请的重点。 我们将首先增强系统的源代码，改进文档和版本管理，并采用 为社区开源开发构建/测试工具(目标1)。然后，我们将开发标准版本和 打包工具，用于管理Rasello mHealth系统的依赖项，生成容器化的运行时，以及 将软件集装箱化以用于工具注册表(目标2)。我们还将重构mHealth系统软件，以 整合标准接口和数据格式，并将定制代码替换为标准的强化库 在指示的地方(目标3)。最后，我们将通过改进Rasello mHealth系统来提高性能 日志记录、监控、代码分析和优化；利用并行化和GPU(目标4)。 Rasello mHealth系统是科学界的宝贵资源，结合了许多需要的 在用户友好的平台中提供功能，以安全地扩展针对各种优先健康问题的财务激励。 随着我们进入R01MH125746的第三年，现在是根据软件来增强系统的理想时机 开放科学的工程最佳实践和原则，这是当父母 这项研究得到了资助。这些活动将提高软件的影响力和可持续性，从而成功 完成母项目，并有可能造福于更广泛的科学界。 1

SUMMARY Financial incentives are an evidence-based intervention to improve engagement in beneficial health behaviors and services for many priority health issues. Our team has extensively studied the benefits of financial incentives for people living with HIV in Tanzania, including through the ongoing Rudi Kundini, Pamoja Kundini (R01MH125746) study. Research from our team and others reveals that financial incentives can increase HIV testing, enhance linkage to care, and bolster treatment adherence. Yet despite this evidence, few financial incentive programs have been scaled for HIV and other urgent health threats sub-Saharan Africa. One reason for this ‘know-do’ gap is that simplified, automated, and secure software for implementing incentive programs at scale have yet to be developed, evaluated, and shared. To meet this need, through collaboration with the Tanzanian Ministry of Health and the Tanzanian technology firm Rasello, we developed an innovative, acceptable, reliable, and scalable software (the “Rasello mHealth system”) to automate incentive distribution. The software securely sends incentives through mobile money, monitors HIV care with biometric identification, sends SMS visit and laboratory test reminders, and integrates with partner databases via application programming interfaces (API). Extensive stakeholder testing has permitted iterative improvement of the software to seamlessly incorporate into clinic workflows. The software is being used in the parent R01 (R01MH125746), but it was not designed to align with software engineering best practices, FAIR4RS principles, or principles of open science, which will limit its impact. Given that this was unforeseen when R01MH125746 was awarded, the Rasello mHealth system is the focus of this application. We will first enhance the system’s source code, improve documentation and version management, and adopt build/test tools for community open-source development (Aim 1). We will then develop standard build and packaging tools to manage the Rasello mHealth system’s dependencies, produce containerized runtimes, and containerize the software for a tool registry (Aim 2). We will also refactor the mHealth system software to incorporate standard interfaces and data formats and replace custom code with standard, hardened libraries where indicated (Aim 3). Lastly, we will improve performance of the Rasello mHealth system through improved logging, monitoring, code profiling and optimization; leveraging parallelization and GPUs (Aim 4). The Rasello mHealth system is a valuable resource for the scientific community, combining many desired features in a user-friendly platform to securely scale financial incentives for a variety of priority health issues. As we enter Year 3 of R01MH125746, now is the ideal time to enhance the system according to software engineering best practices and principles of open science, a need which was unanticipated when the parent study was funded. These activities will improve the impact and sustainability of the software to successfully complete the parent project and has potential to benefit the broader scientific community. 1