DOI: 10.5061/dryad.c59zw3r93
title: Costing data for implementing mHealth facilitated tuberculosis contact tracing in Uganda

description: Introduction Mobile health (mHealth) applications may improve timely
 access to health services and improve patient-provider communication, but
 the upfront costs of implementation may be prohibitive, especially in
 resource-limited settings. Methods We measured the costs of developing and
 implementing an mHealth-facilitated, home-based strategy for tuberculosis
 (TB) contact investigation (CI) in Kampala, Uganda, between February 2014
 and July 2017. We compared routine implementation involving community
 health workers (CHWs) screening and referring household contacts to
 clinics for TB evaluation to home-based HIV testing and sputum collection
 and transport with test results delivered by automated short messaging
 services (SMS) We carried out key informant interviews with CHWs and asked
 them to complete time-and-motion surveys. We estimated program costs from
 the Ugandan health system perspective, using top-down and bottom-up
 (components-based) approaches. We estimated total costs per contact
 investigated and per TB-positive contact identified in 2018 US dollars,
 one and five years after program implementation. Results  The
 total top-down cost was $472,327, including $358,504 (76%) for
 program development and $108,584 (24%) for program implementation. This
 corresponded to $320-$348 per household contact investigated and
 $8873-$9652 per contact diagnosed with active TB over a 5-year period. CHW
 time was spent primarily evaluating household contacts who returned to the
 clinic for evaluation (median 30 minutes per contact investigated,
 interquartile range [IQR]: 30-70), collecting sputum samples (median 29
 minutes, IQR: 25-30) and offering HIV testing services (median 28 minutes,
 IQR: 17- 43). Cost estimates were sensitive to infrastructural capacity
 needs, program reach, and the epidemiologic yield of contact
 investigation.  Conclusion Over 75% of all costs of the
 mHealth-facilitated TB contact investigation strategy were dedicated to
 establishing mHealth infrastructure and capacity. Implementing the mHealth
 strategy at scale and maintaining it over a longer time horizon could help
 decrease development costs as a proportion of total costs.
description: We measured the costs of developing and implementing an
 mHealth-facilitated, home-based strategy for tuberculosis (TB) contact
 investigation (CI) in Kampala, Uganda, between February 2014 and July
 2017. We compared routine implementation involving community health
 workers (CHWs) screening and referring household contacts to clinics for
 TB evaluation to home-based HIV testing and sputum collection and
 transport with test results delivered by automated short messaging
 services (SMS) We carried out key informant interviews with CHWs and asked
 them to complete time-and-motion surveys. We estimated program costs from
 the Ugandan health system perspective, using top-down and bottom-up
 (components-based) approaches. We estimated total costs per contact
 investigated and per TB-positive contact identified in 2018 US dollars,
 one and five years after program implementation.