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 Implement...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-023-00448-w |
| _version_ | 1797795673744080896 |
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| author | Amanda J. Gupta Patricia Turimumahoro Emmanuel Ochom Joseph M. Ggita Diana Babirye Irene Ayakaka David Mark Daniel Ayen Okello Adithya Cattamanchi David W. Dowdy Jessica E. Haberer Mari Armstrong-Hough Achilles Katamba J. Lucian Davis |
| author_facet | Amanda J. Gupta Patricia Turimumahoro Emmanuel Ochom Joseph M. Ggita Diana Babirye Irene Ayakaka David Mark Daniel Ayen Okello Adithya Cattamanchi David W. Dowdy Jessica E. Haberer Mari Armstrong-Hough Achilles Katamba J. Lucian Davis |
| author_sort | Amanda J. Gupta |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T03:21:34Z |
| format | Article |
| id | doaj.art-cb70f2b7ca224a83b62a3d66b0fc09f2 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-03-13T03:21:34Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-cb70f2b7ca224a83b62a3d66b0fc09f22023-06-25T11:18:46ZengBMCImplementation Science Communications2662-22112023-06-014111210.1186/s43058-023-00448-wmHealth to improve implementation of TB contact investigation: a case study from UgandaAmanda J. Gupta0Patricia Turimumahoro1Emmanuel Ochom2Joseph M. Ggita3Diana Babirye4Irene Ayakaka5David Mark6Daniel Ayen Okello7Adithya Cattamanchi8David W. Dowdy9Jessica E. Haberer10Mari Armstrong-Hough11Achilles Katamba12J. Lucian Davis13Department of Epidemiology of Microbial Diseases, Yale School of Public HealthUganda Tuberculosis Implementation Research Consortium, Makerere UniversityUganda Tuberculosis Implementation Research Consortium, Makerere UniversityUganda Tuberculosis Implementation Research Consortium, Makerere UniversityUganda Tuberculosis Implementation Research Consortium, Makerere UniversityUganda Tuberculosis Implementation Research Consortium, Makerere UniversityUganda Tuberculosis Implementation Research Consortium, Makerere UniversityKampala Capital City AuthorityUganda Tuberculosis Implementation Research Consortium, Makerere UniversityUganda Tuberculosis Implementation Research Consortium, Makerere UniversityDepartment of Medicine, Massachusetts General Hospital, Harvard Medical SchoolUganda Tuberculosis Implementation Research Consortium, Makerere UniversityUganda Tuberculosis Implementation Research Consortium, Makerere UniversityDepartment of Epidemiology of Microbial Diseases, Yale School of Public HealthAbstract 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.https://doi.org/10.1186/s43058-023-00448-wTuberculosisContact tracingAfricaDigital technology |
| spellingShingle | Amanda J. Gupta Patricia Turimumahoro Emmanuel Ochom Joseph M. Ggita Diana Babirye Irene Ayakaka David Mark Daniel Ayen Okello Adithya Cattamanchi David W. Dowdy Jessica E. Haberer Mari Armstrong-Hough Achilles Katamba J. Lucian Davis mHealth to improve implementation of TB contact investigation: a case study from Uganda Implementation Science Communications Tuberculosis Contact tracing Africa Digital technology |
| title | mHealth to improve implementation of TB contact investigation: a case study from Uganda |
| title_full | mHealth to improve implementation of TB contact investigation: a case study from Uganda |
| title_fullStr | mHealth to improve implementation of TB contact investigation: a case study from Uganda |
| title_full_unstemmed | mHealth to improve implementation of TB contact investigation: a case study from Uganda |
| title_short | mHealth to improve implementation of TB contact investigation: a case study from Uganda |
| title_sort | mhealth to improve implementation of tb contact investigation a case study from uganda |
| topic | Tuberculosis Contact tracing Africa Digital technology |
| url | https://doi.org/10.1186/s43058-023-00448-w |
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