JMIR Publications

ABSTRACT

Background:

Despite increasing smartphone penetration globally, personalized mobile health (mHealth) care interventions remain largely untapped for support of people with tuberculosis (TB). An evidence-based multi-feature smartphone platform for HIV care tailored and widely implemented in the US may enhance treatment quality and completion in the Kilimanjaro context.

Objective:

We aimed to evaluate contextual determinants of mHealth implementation in the Kilimanjaro region to ensure feasibility, acceptability, and effective adaptation of the platform for TB care within Kilimanjaro.

Methods:

We conducted semi-structured in-depth interviews at Kilimanjaro Christian Medical Centre (KCMC) and Kibong’oto Infectious Diseases Hospital (KIDH) with people with TB (PWTB) (aged 18+ with drug-susceptible/-resistant TB, with/without HIV, and > 1 month on treatment) and providers/staff (e.g. clinicians, community health workers, laboratory staff). Interview guides were designed using Bury’s Framework for Chronic Illness and the Consolidated Framework for Implementation Research (CFIR), along with an overview of an existing smartphone-based program called PositiveLinks.

Results:

We conducted 14 interviews with PWTB and 11 provider/staff interviews. Several unmet TB treatment needs emerged along with suggestions for platform adaptation and implementation strategies. Findings suggest high personal smartphone access among providers/staff (100%), less so for PWTB interviewed (36%). High provider digital literacy/capability and usage was noted, with smartphone apps routinely used for TB care delivery independent of electronic health systems. PWTB primarily used mobile phones for communication (calls) with clinic providers and staff for care coordination (e.g. reminders). Internet access and stability remain a barrier in rural clinics, along with personal cost of data bundles for both stakeholder groups. Key assets identified within the inner setting of KCMC and KIDH include existing provider/staff commitment to treatment support outside of clinic visits, and a robust infrastructure of community outreach for support of adherence and retention for PWTB.

Conclusions:

Real-world considerations for the context suggest implementation of provider-facing smartphone interventions would be highly feasible and acceptable with appropriate consideration of personal cost associated with usage among stakeholders. Patient-facing or bi-directional tools would require modifications to existing mHealth implementation strategies, including more comprehensive assessment of digital literacy and related training, as well as provision of subsidized devices and data bundles.