MILEAGE4TB: Using short message service reminders and mobile money incentives to enhance linkage to care of presumptive tuberculosis patients in uganda: a randomised controlled trial

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 an increase in 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.