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

Abstract

BACKGROUND Suboptimal tuberculosis (TB) medication adherence can lead to treatment failure, the development of drug-resistant TB, and secondary transmission. Digital adherence technologies (DATs) such as real-time monitors and SMS reminders can improve TB treatment adherence. However, financial constraints can limit their utility. The design of mechanisms to incorporate financial support into DATs for TB treatment remains unclear OBJECTIVE This paper describes the perceived usefulness and design mechanisms for a DAT intervention called My Mobile Wallet which is composed of real-time adherence monitor, SMS reminders, and mobile money incentives to improve TB medication adherence in a low-income setting. METHODS This study employed mixed methods approaches among persons living with tuberculosis (PLTB) recruited from the TB Clinic in the Mbarara Regional Referral Hospital. We purposively sampled 21 PLWTB aged 18 years and older, who owned cell phones, and were able to use SMS. We also enrolled 9 participants who used DATs in our previous study. We used focus group discussions with the 30 participants to solicit perceptions about the initial version of the My Mobile Wallet intervention, and iteratively refined subsequent versions of the intervention following a user-centered design approach until the beta version of the intervention that suited their needs was developed. We also administered surveys eliciting information about participants’ cell phone use and perceptions of the intervention. We used content analysis to inductively analyze data to derive categories describing the perceived usefulness of the intervention and design mechanisms. We used STATA 13 to analyze survey data. RESULTS Participants expressed the perceived usefulness of the My Mobile Wallet intervention in terms of being cared for as a result of being monitored, sent an SMS reminder, or receiving a financial incentive, which could subsequently motivate and support medication taking. To address possibilities of unintended TB status disclosure and using the money meant for transport to the clinic for other competing demands, participants suggested using SMS language that is confidential and not easily related to TB and sending transport refund a day before the appointment to limit the time lag between receiving the money and visiting the clinic. CONCLUSIONS Digital adherence technologies complemented with mobile money financial incentives could potentially provide acceptable approaches to remind, motivate and support patients to adhere to taking their TB medication CLINICALTRIAL ClinicalTrials.gov NCT05656287