Operational Time Range
Summary of the project
This study aims to build capacity in mHealth tuberculosis (TB) research and clinical trials with a focus on TB presumptive patients. Worldwide, national TB programs try to improve case detection rates and monitoring treatment outcomes, but little is known about the proportion of presumptive TB cases that never get tested for TB and the confirmed TB cases that never start treatment in endemic areas like Uganda, despite high prevalence and mortality rates. Uganda notified 43,736 total TB cases in 2015, of these only 53% received TB treatment. Patients can be lost to follow-up (LTFU) after being identified as presumptive TB cases and never get to test for TB or those who test and are confirmed to have TB, can also be lost and never start TB treatment. A systematic review found high levels of pre-treatment LTFU–ranging from 4 to 38%–,and was higher in sub-Saharan Africa (18%) compared to Asia (13%). Consequences of pre-diagnosis and pre-treatment LTFU are; untreated TB patients are infectious and can transmit TB to others and not starting TB treatment at all, causes high morbidity and mortality. Therefore, monitoring outcomes of presumptive TB patients is equally important as monitoring treatment outcomes. Short message service (SMS) and mobile money (MM) incentives have shown promise by improving health outcomes such as uptake of immunization, adherence to TB treatment and ART. However, there is limited knowledge on whether text messages and MM incentives can increase linkage to care and treatment for presumptive TB patients in Uganda and sub-Saharan Africa. The aim of this study is to leverage SMS reminders and MM incentives in improving linkage to care of presumptive TB patients. We believe this will result in increase the proportion of presumptive TB patients that complete diagnosis and pre-treatment TB cases that link to care and treatment using SMS reminders and Mobile Money (MM) incentives.
1. To evaluate the TB diagnostic process and linkage to care by doing cohort analysis.
2. Develop and adapt SMS reminders and MM incentives to improve linkage to care among TB patients.
3. Conduct a randomized controlled trial of SMS reminders and MM incentives sent to presumptive and confirmed TB patients to improve linkage to care and treatment.
4. To build sustainable capacity in clinical trials and mHealth for TB in Uganda. We will support 3 masters and 1 Ph.D. student in the areas of TB and mHealth.
The study will utilize various methods including qualitative and quantitative ones.
Profile of the Principal Investigator and fellow
Esther Buregyeya is a Ugandan physician trained in public health and a research expert in disease control. She is an Assoc. Professor and Chair of the Department of Disease Control and Environmental Health at Makerere University School of Public Health. Dr. Buregyeya has over 16 years of experience in service including clinical work in a district as a medical officer, teaching and research. She has a strong background in field research with over 10 years of experience in designing and implementing community and facility-based research, mainly in tuberculosis, HIV, malaria and mHealth. Dr. Buregyeya has experience in doing longitudinal research including clinical trials in HIV and malaria. She also has experience in qualitative research methods and implementation science. She is committed to seeking innovative solutions to public health problems with a specific focus on TB and HIV. She has recently gained interest and expertise in the use of mHealth technologies to improve linkage to care and retention as well as adherence to treatment among tuberculosis patients. She is an active member of the mHealth Interest Group (MIG) that promotes research awareness of the state of the mHealth field at the Makerere School of Public Health and also currently implementing with a team from University of Georgia an R021 grant (1R21 TW011365-01-Juliet Sekandi ) ‘DOT Selfie: A Mobile Health Intervention with Transfer of Social Bundle Incentives to Increase Treatment Adherence in Tuberculosis Patients in Uganda.’ Dr. Buregyeya has been engaged in capacity building and mentorship programs for more about 15 years as a Lecturer. She participates in teaching research methods, communicable and non-communicable disease control interventions (including monitoring and evaluation) for undergraduate and graduate students. She has also supervised more than 20 graduate students to completion. Through these years, she has developed capabilities to design, implement and lead research and program activities.
My career development plans include;
Dr. Buregyeya’s career development plans include;
- Being able to design, plan and implement complex research projects. Through this fellowship, she will be able to acquire these skills given the project she has proposed, as well the mentors she has.
- Publish her findings in higher impact journals as well as share them in high profile research meetings and
- Developing skills to mentor and supervise a PhD student. During and after the fellowship, she will be able to actively participate in grant writing with multidisciplinary teams and supervise graduate students as well as publish her research findings widely.