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

联系Pi(最后、第一、中间)：Musiimenta，Angella 项目总结 重要意义：乌干达结核病(TB)负担沉重，患病率为每10万人253人 发病率为每10万人201人。糟糕的结核病药物限制了治疗的成功 并增加其传播率。有条件或无条件现金形式的财政奖励 转移显示出改善结核病护理的希望，但这种方法主要在#年实施 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交流 互动。建议干预：My Mobile Wallet是一种新颖的行为和经济干预措施 利用短信提醒服药依从性，并利用移动支付方式提供交通 并激励患者坚持服药。我们的总体假设是，我的移动钱包将 克服目前制约结核病药物治疗的行为问题、关键财务问题和激励问题 坚持不懈。创新：据我们所知，我们的研究是第一次客观地结合评估 衡量的遵从性、短信提醒和基于行为经济学的激励(通过移动设备提供 资金)，以支持结核病药物治疗的坚持。方法：在R21目标1中，我们首先确定最优设计 并开发我的移动钱包作为一种干预措施，以支持结核病药物治疗的坚持。使用以用户为中心 方法，我们将反复与从结核病中心招募的多达30名结核病患者进行焦点小组讨论。 姆巴拉拉地区转诊医院(MRRH)的诊所。然后，我们评估初步的可行性和可接受性 在R21 Aim 2中使用我的移动钱包支持结核病药物治疗，基于40名患有新诊断的结核病的成年人 活动性的、对药物敏感的结核MRRH。可行性将通过收到现金转账、收到短信、 以及遇到的技术问题。可接受性将通过系统可用性和面谈进行评估 基于技术接受和使用的统一理论。在R33目标1中，我们进一步细化和调整我的 移动钱包，然后在两个月的治疗过程中在10名结核病患者中进行试点测试，以确保最佳 功能性。然后，我们评估改进的My Mobile Wallet干预的大规模可行性、可接受性、 以及通过随机对照试验对结核病治疗依从性和临床结果的影响(R33目标2) 由162例肺结核患者组成，随访6个月。可行性和可接受性将按照所述进行评估 上面。影响评估也将基于电子监测的服药依从性(主要) 治疗完成率、就诊次数、治愈率和死亡率(次要指标)。调查人员/环境： 我们的团队带来了移动健康技术设计和采用以及行为科学(DRS)方面的专业知识 Musiimenta和Haberer)和行为经济学(Linnemayr博士)。未来方向：我的手机钱包是 设计满足有限的基础设施需求，从而创造了在现实世界中大规模实施的潜力 可以在未来的多站点随机集群中测试(R01授权)。

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).