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. 2025 Oct 3;6(1):100.
doi: 10.1186/s43058-025-00766-1.

Scaling-up an mHealth system to deliver financial incentives to improve adherence to antiretroviral therapy in Tanzania

Emmanuel Katabaro  1 , Babuu Joseph  1 , Natalino Mwenda  2 , Puspa Bhattarai  2 , Janeth Msasa  1 , Agatha Mnyippembe  1 , Hamza Maila  1 , Kassim Hassan  1 , Jacqueline Kunesh  3 , Amon Sabasaba  1 , Solis Winters  4 , Prosper Njau  1   5 , Rebecca Hémono  6 , Sandra I McCoy  4 , Laura Packel  7
Affiliations

Scaling-up an mHealth system to deliver financial incentives to improve adherence to antiretroviral therapy in Tanzania

Emmanuel Katabaro et al. Implement Sci Commun. .

Abstract

Background: Financial incentives are increasingly used to achieve UNAIDS' 95-95-95 goals for ending HIV by 2030. While evidence supports their effectiveness, scaling these interventions remains challenging. This study examines the implementation successes and challenges of a financial incentive intervention in Tanzania, delivered via an mHealth application that provides automated mobile money disbursements, biometric identification, and SMS reminders.

Methods: Conducted alongside a Hybrid Type 1 Effectiveness-Implementation trial, the study evaluated financial incentives given to adults starting ART at 32 clinics. We used the Structured Assessment of Feasibility, Compatibility Beliefs in Technology (CBIT) scales, and the Program Sustainability Assessment Tool. Perspectives from 657 participants living with HIV and 90 clinic staff were collected using Proctor's implementation science framework.

Results: Clinic staff rated the mHealth system highly on CBIT subscales for perceived usefulness, ease of use, and compatibility, each scoring over 6 out of 7. Integration and applicability of the financial incentive within the mHealth system were well received, with 93.0% of staff agreeing it improved job performance. Among participants, 86.4% found SMS reminders helpful for attending appointments, and 76.7% felt the cash delivery met their expectations. Challenges included unreliable fingerprint identification and undelivered SMS reminders.

Conclusions: Despite issues with fingerprint identification and SMS delivery, the financial incentive intervention via mHealth was found to be acceptable, feasible, and potentially sustainable in resource-limited settings, with support from host governments. Future research should enhance the intervention's effectiveness and optimize biometric identification methods.

Trial registration: ClinicalTrials.gov NCT04201353. Registered 17 December 2019, https://clinicaltrials.gov/study/NCT04201353.

Keywords: 95–95-95 goals; Appointment reminders; Financial incentive; Implementation Science; People Living with HIV (PLHIV); mHealth.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the University of California, Berkeley Office for Protection of Research Subjects and by the National Medical Research Institute of Tanzania. All study participants were required to provide written informed consent prior to study participation. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

References

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