mHealth to improve implementation of TB contact investigation: a case study from Uganda

Abstract

Background Implementation science offers a systematic approach to adapting innovations and delivery strategies to new contexts but has yet to be widely applied in low- and middle-income countries. The Fogarty Center for Global Health Studies is sponsoring a special series, “Global Implementation Science Case Studies,” to address this gap. Methods We developed a case study for this series describing our approach and lessons learned while conducting a prospective, multi-modal study to design, implement, and evaluate an implementation strategy for TB contact investigation in Kampala, Uganda. The study included formative, evaluative, and summative phases that allowed us to develop and test an adapted contact investigation intervention involving home-based sample collection for TB and HIV testing. We concurrently developed a multi-component mHealth implementation strategy involving fingerprint scanning, electronic decision support, and automated reporting of test results via text message. We then conducted a household-randomized, hybrid implementation-effectiveness trial comparing the adapted intervention and implementation strategy to usual care. Our assessment included nested quantitative and qualitative studies to understand the strategy’s acceptability, appropriateness, feasibility, fidelity, and costs. Reflecting on this process with a multi-disciplinary team of implementing researchers and local public health partners, we provide commentary on the previously published studies and how the results influenced the adaptation of international TB contact investigation guidelines to fit the local context. Results While the trial did not show improvements in contact investigation delivery or public health outcomes, our multi-modal evaluation strategy helped us identify which elements of home-based, mHealth-facilitated contact investigation were feasible, acceptable, and appropriate and which elements reduced its fidelity and sustainability, including high costs. We identified a need for better tools for measuring implementation that are simple, quantitative, and repeatable and for greater attention to ethical issues in implementation science. Conclusions Overall, a theory-informed, community-engaged approach to implementation offered many learnings and actionable insights for delivering TB contact investigation and using implementation science in low-income countries. Future implementation trials, especially those incorporating mHealth strategies, should apply the learnings from this case study to enhance the rigor, equity, and impact of implementation research in global health settings.

Barriers and facilitators of implementing electronic monitors to improve adherence and health outcomes in tuberculosis patients: protocol for a systematic review based on the Consolidated Framework for Implementation Research

“…These studies have demonstrated the strengths of utilizing the CFIR in various types of research, including qualitative [ 54 , 55 , 65 – 67 , 69 , 71 , 73 , 75 , 77 , 79 ], quantitative [ 53 ], mixed methods [ 76 ] and case studies [ 72 ]. Qualitative studies have employed the CFIR as an interview design and guide and collection tool to explore the perspectives and engagement of healthcare system stakeholders concerning implementation readiness [ 54 , 55 , 65 – 67 , 69 , 71 , 73 , 75 , 77 , 79 ]. However, it should be noted that the success of information capture may vary across specific constructs [ 66 ].…”

“…It helped identify factors that promote or undermine implementation success, guiding practical and programmatic implications. Additionally, it also allowed for the evaluation of scalability and generalization across cities and countries [ 55 , 66 , 68 , 69 , 73 , 79 ].…”

Apply Dots M-Health terhadap Peningkatan Minum Obat dan Kualitas Hidup Pasien Tuberkulosis Paru

“…Oleh karena ulasan di atas dapat menjadi salah satu penguat bahwa pemantauan melalui penerapan teknologi digital diharapkan mampu menjadi salah satu solusi untuk meningkatkan pengobatan pasien Tuberkulosis Paru pada fase lanjutan/jangka panjang hingga dinyatakan tuntas (Balaji et al, 2022;Gashu et al, 2021;Gupta et al, 2023;Turimumahoro et al, 2022). Dengan adanya pengingat melalui SMS atau pengingat lainnya pasien akan merasa terbantu dan merasa diperhatikan dalam menginat jadwal meminum obat.…”