Costing data for implementing mHealth facilitated tuberculosis contact tracing in Uganda

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.