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DOT Selfie: A Mobile Health Intervention with Transfer of Social Bundle Incentives to Increase Treatment Adherence in Tuberculosis Patients in Uganda

Award Number: R21TW011365
ORGANIZATION: FOGARTY INTERNATIONAL CENTER
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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1.0 Abstract Tuberculosis (TB) is one of the deadliest infectious diseases and a killer of 1.7 million people worldwide in 2016, majority of whom were in low- and middle-income countries. Medication non-adherence is a common, complex, and costly problem. Non-adherence to treatment is a major obstacle to TB control: it reduces cure rates, prolongs infectiousness, and contributes to the emergence of multi-drug resistant strains of TB. Careful monitoring and support of treatment adherence is needed to mitigate the rapid emergence of MDR-TB and other adverse disease outcomes. The lack of a sufficient number of health workers and the cost of travel makes it particularly challenging to implement the current standard in-person directly observed therapy (DOT). We propose to adapt and test an existing mobile health intervention -video directly observed therapy (VDOT), for use in the local Ugandan context. The adapted intervention dubbed “DOT Selfie” is expected to provide a new alternative way for health providers to monitor patients remotely. First, “DOT Selfie” will entail a patient using a smartphone to record and send a time-stamped encrypted video showing his/her medications intake each day. This video component will directly substitute the need for daily face-to-face meetings between the provider and patient thereby minimize costly travel. Second, the patient will also receive daily SMS text reminders translated in Luganda and a weekly reward if they send their videos. This component will enhance patient- provider interaction while motivating desired adherence behavior. The provider logs on a secured computer system to verify treatment adherence. We hypothesize that, by eliminating the need for daily travel, allowing patients to take their pills anywhere and providing incentives to TB patients, DOT Selfie will increase treatment adherence. The long-term goal of this project is to establish DOT Selfie as an effective way to improve medication adherence in TB treatment in an African context. To achieve this goal, it will be critical to perform reliable research to assess effectiveness of contextualized mHealth tools and also to build a knowledgeable and competent workforce that will properly implement mHealth interventions in Africa. In partnership with Makerere University in Uganda, the Uganda National TB Program and researchers at the University of Georgia, the team will work to address the scientific and capacity building objectives through these Specific Aims. First, we will conduct qualitative interviews to identify perceived barriers to use of mHealth tools among patients and providers. Second, we will test the adapted DOT Selfie intervention for monitoring adherence among 30 TB patients compared to those in standard of care. Finally, we will use a multi-prong approach to build and strengthen the capacity for mHealth research at Makerere University and within the National TB Program in Uganda. The results will be applicable to other African settings and to a range of chronic diseases with lifelong treatment such HIV/AIDs.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2020	UNIVERSITY OF GEORGIA RESEARCH FOUNDATION, INC.	310 EAST CAMPUS RD TUCKER HALL ROOM 409	ATHENS	GA	30602	CLARKE	USA	International Research and Research Training	000	2	3/13/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $0 )
2022	2021	UNIVERSITY OF GEORGIA RESEARCH FOUNDATION, INC.	310 EAST CAMPUS RD TUCKER HALL ROOM 409	ATHENS	GA	30602	CLARKE	USA	International Research and Research Training	000	2	11/9/2021	SUPPLEMENT FOR EXPANSION	$0
2022	2020	UNIVERSITY OF GEORGIA RESEARCH FOUNDATION, INC.	310 EAST CAMPUS RD TUCKER HALL ROOM 409	ATHENS	GA	30602	CLARKE	USA	International Research and Research Training	001	2	4/12/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2021 ( Subtotal = $37,790 )
2021	2021	UNIVERSITY OF GEORGIA RESEARCH FOUNDATION, INC.	310 EAST CAMPUS RD TUCKER HALL ROOM 409	ATHENS	GA	30602	CLARKE	USA	International Research and Research Training	000	2	5/5/2021	SUPPLEMENT FOR EXPANSION	$37,790
														Subtotal = $37,790

Issue Date FY: 2020 ( Subtotal = $163,608 )
2020	2020	UNIVERSITY OF GEORGIA RESEARCH FOUNDATION, INC.	310 EAST CAMPUS RD TUCKER HALL ROOM 409	ATHENS	GA	30602	CLARKE	USA	International Research and Research Training	000	2	4/23/2020	NON-COMPETING CONTINUATION	$163,608
2020	2020	UNIVERSITY OF GEORGIA RESEARCH FOUNDATION, INC.	310 EAST CAMPUS RD TUCKER HALL ROOM 409	ATHENS	GA	30602	CLARKE	USA	International Research and Research Training	001	2	6/26/2020	NON-COMPETING CONTINUATION	$0
														Subtotal = $163,608

Issue Date FY: 2019 ( Subtotal = $169,613 )
2019	2019	UNIVERSITY OF GEORGIA RESEARCH FOUNDATION, INC.	310 EAST CAMPUS RD TUCKER HALL ROOM 409	ATHENS	GA	30602	CLARKE	USA	International Research and Research Training	000	1	7/27/2019	NEW	$169,613
2019	2019	UNIVERSITY OF GEORGIA RESEARCH FOUNDATION, INC.	310 EAST CAMPUS RD TUCKER HALL ROOM 409	ATHENS	GA	30602	CLARKE	USA	International Research and Research Training	001	1	8/30/2019	NEW	$0
														Subtotal = $169,613

Grand Total All Awards = $371,011

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DOT Selfie: A Mobile Health Intervention with Transfer of Social Bundle Incentives to Increase Treatment Adherence in Tuberculosis Patients in Uganda

Award Number: R21TW011365

ORGANIZATION: FOGARTY INTERNATIONAL CENTER

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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