Impact of a mobile phone-based interactive voice response software on tuberculosis treatment outcomes in Uganda (CFL-TB): a protocol for a randomized controlled trial.

BACKGROUND: Throughout the last decade, tuberculosis (TB) treatment success has not surpassed 90%, the global target. The impact of mobile health interventions (MHIs) on TB treatment outcomes is unknown, especially in low- and middle-income countries (LMICs). MHIs, including interactive voice response technology (IVRT), may enhance adherence and retention in the care of patients with tuberculosis and improve TB treatment outcomes. This study seeks to determine the impact of IVRT-based MHI on TB treatment success (treatment completion and cure rates) in patients with TB receiving care at five public health facilities in Uganda. METHODS: We used a theory-based and human-centered design (HCD) to adapt an already piloted software to design "Call for life-TB" (CFL-TB), an MHI that utilizes IVRT to deliver adherence and appointment reminders and allows remote symptom reporting. This open-label, multicenter, randomized controlled trial (RCT), with nested qualitative and economic evaluation studies, will determine the impact of CFL-TB on TB treatment success in patients with drug-susceptible TB in Uganda. Participants (n = 274) at the five study sites will be randomized (1:1 ratio) to either control (standard of care) or intervention (adherence and appointment reminders, and health tips) arms. Multivariable regression models will be used to compare treatment success, adherence to treatment and clinic appointments, and treatment completion at 6 months post-enrolment. Additionally, we will determine the cost-effectiveness, acceptability, and perceptions of stakeholders. The study received national ethical approval and was conducted in accordance with the international ethical guidelines. DISCUSSION: This randomized controlled trial aims to evaluate interactive voice response technology in the context of resource-limited settings with a high burden of TB and high illiteracy rates. The software to be evaluated was developed using HCD and the intervention was based on the IMB model. The software is tailored to the local context and is interoperable with the MHI ecosystem. The HCD approach ensures higher usability of the MHI by integrating human factors in the prototype development. This research will contribute towards the understanding of the implementation and impact of the MHI on TB treatment outcomes and the health system, especially in LMICs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04709159 . Registered on January 14, 2021

Occupational Injuries and use of Personal Protective Equipment among Casual Municipal Solid Waste Workers in the Informal Sector in Kampala: A Cross-Sectional Study.: Occupational injuries in informal waste workers.

Introduction: The risk of occupational injuries in municipal solid waste workers in most low- and middle-income countries is increasing. This study sought to determine the use of PPE and its association with injuries among casual waste workers in a prototypical city. Methods: This was a cross-sectional study of casual waste workers at a large city landfill site in Kampala, Uganda. Structured questionnaires were used to obtain data on PPE use and occupational injuries within one year before the study. Multivariate logistic regression was used to determine the relationship between PPE use and occupational injury. Results: The study was conducted between May 2020 and December 2020 and enrolled 81 participants, 44 (54%) of whom were male. Overall, 27 (33%) reported not using PPE, while 53 (65%) reported experiencing injuries. In the multivariable logistic regression model, the use of PPE was associated with lower odds of injury (odds ratio [OR] 0.09, 95% 95% confidence interval [95% CI], 0.01–0.57; P=0.011). In contrast, perceived risk was associated with a greater risk of injury (OR 34.95; 95% CI, 7.00, 174.56; P<0.001). Prior training on PPE use (adjusted odds ratio, AOR 44.69; 95% CI 6.12–342.02; P=0.002), and older age (AOR 1.16; 95% CI 1.03–1.31; P=0.014), were associated with higher odds of PPE use. Additionally, waste pickers and sorters were more likely to use PPE than site traders. Conclusions: Among casual waste workers, there was suboptimal use of PPE and a high rate of occupational injuries. This study suggests that the non-use of PPE may be due to a lack of access and training. Recommendations: We recommend surveillance of injuries among workers in the waste management sector as well as regular training in routine and proper use of PPEs