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Implementation outcomes of tuberculosis digital adherence technologies: a scoping review using the RE-AIM framework
Chimweta I Chilala1, Nicola Foster1, Shruti Bahukudumbi2
1Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
BMJ Global Health
|February 13, 2025
Summary
Digital adherence technologies (DATs) show promise for tuberculosis (TB) treatment, but reach is limited by cellphone access and engagement barriers. Video and pillbox DATs demonstrate higher engagement, though implementation challenges persist.
Area of Science:
- Public Health
- Infectious Diseases
- Health Technology
Background:
- Tuberculosis (TB) remains a leading global cause of death, necessitating innovative treatment strategies.
- Digital Adherence Technologies (DATs) offer potential for person-centered care and improved TB treatment outcomes.
Purpose of the Study:
- To conduct a scoping review of Digital Adherence Technologies (DATs) for tuberculosis (TB) treatment using the RE-AIM framework.
- To evaluate the reach, effectiveness, adoption, implementation, and maintenance of DATs in TB care.
Main Methods:
- A systematic search of seven databases was conducted for studies published between January 2000 and April 2023.
- Keywords included 'tuberculosis' and 'digital adherence technology'.
- Articles were included if they met prespecified criteria and reported on RE-AIM domains.
Main Results:
- 102 studies synthesized findings on various DATs (SMS, phone, 99DOTS, VST, pillboxes).
- Cellphone access varied (50%-100%), with 2%-31% of people with TB excluded due to technology. DAT engagement rates ranged from 61% to 87%.
- Implementation fidelity was impacted by technological issues and provider-related challenges; adoption and maintenance data were limited.
Conclusions:
- DATs face significant reach limitations due to cellphone accessibility and sustained engagement challenges.
- Video and pillbox DATs show higher engagement, but technological and provider issues hinder implementation.
- Enhancing implementation strategies is crucial for maximizing the public health impact of DATs in TB treatment.
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