Enhancing tuberculosis care in lower and middle-income countries through digital adherence technologies

Area of Science:

• Public Health
• Health Technology Assessment
• Global Health

Background:

• Tuberculosis (TB) is a significant global health issue, especially in LMICs.
• Treatment adherence is crucial for TB control but remains a challenge.
• Digital Adherence Technologies (DATs) offer potential solutions for improving TB care.

Purpose of the Study:

• To evaluate the role and challenges of DATs in enhancing TB treatment adherence in LMICs.
• To assess the cost-effectiveness and equity implications of DAT implementation.
• To identify strategies for successful DAT adoption and scale-up.

Main Methods:

• Review of existing literature on DATs for TB treatment adherence.
• Analysis of cost-effectiveness data from various LMIC contexts.
• Examination of equity concerns, including intervention-generated inequality.
• Identification of implementation challenges and facilitators.

Main Results:

• DATs show potential for improving TB treatment adherence, with some low-cost options like 99DOTS emerging.
• Cost-effectiveness findings are mixed across different LMICs.
• DAT implementation can exacerbate or mitigate health inequities depending on targeting and context.
• Challenges include infrastructure, cost, technology fatigue, data privacy, and socioeconomic factors.

Conclusions:

• DATs can enhance TB care and adherence in LMICs, but require context-specific strategies.
• Addressing equity and tailoring interventions to local needs are critical for success.
• Global health initiatives and funding are essential to scale up DATs for TB elimination.