Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Feb 21, 2020
Date Accepted: Aug 17, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A Cost Analysis of an Interactive SMS Intervention to Improve Adherence to Option B+ Prevention of Mother-to-child HIV Transmission in Kenya
ABSTRACT
Background:
Mobile health (mHealth) approaches offer potentially affordable ways to support care of HIV-infected patients in overstretched healthcare systems. However, few studies have analyzed costs associated with mHealth solutions for HIV care.
Objective:
This study estimates the total incremental costs and incremental cost per beneficiary of an interactive SMS support intervention within a clinical trial.
Methods:
The Mobile WAChX trial (NCT02400671) evaluates an interactive semi-automated SMS intervention to improve ART adherence and retention in care among peripartum women in Kenya. Women were randomized to receive one-way vs. two-way SMS. Messages were sent weekly, including motivational and educational content and visit reminders; two-way messaging enabled prompt consultation with nurse as needed. Micro-costing methods were used to collect resource-use related to implementing the Mobile WAChX SMS intervention. At 2 sites (Nairobi and Western Kenya), we conducted semi-structured interviews with health personnel to identify start-up and recurrent activities, obtaining information on personnel, supplies, and equipment. Data on expenditures and prices from project expense reports, administrative records and published government salary data were included to estimate total incremental costs. Using a public provider perspective, we estimated incremental unit costs per beneficiary and per contact during 2017.
Results:
The weighted average annual incremental costs were $3,725 per facility for the two-way messaging group, $62 per beneficiary and $0.85 per contact to reach 115 beneficiaries. For the one-way messaging group, the weighted average annual incremental costs were $2,542 per facility, $42 per beneficiary and $0.66 per contact to reach 117 beneficiaries. The majority of costs were for personnel, 48% in two-way and 33% in one-way messaging groups, respectively. Costs associated with software development and communication accounted for 30% of costs in both intervention arms.
Conclusions:
Cost information for budgeting and financial planning is relevant for implementing mHealth interventions in national health plans. Given the proportion of costs related to systems development, it is likely that costs per beneficiary will decline with scale-up.
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