Digital Technologies for Tuberculosis Treatment Adherence
Summary
Tuberculosis remains a leading cause of infectious mortality worldwide, with treatment adherence posing a critical challenge to control efforts. Conventional directly observed therapy (DOT) can impose significant burdens on patients and health services, especially in resource-limited settings. Digital adherence technologies (DATs) offer patient-centred alternatives by harnessing mobile phones, sensors and cloud-based platforms to monitor and support medication intake remotely. Common approaches include short message service (SMS) reminders, electronic medication monitors that log box openings, and video-observed therapy (VOT) in which patients record and transmit ingestion events. These innovations aim to reduce clinic visits, optimise healthcare resources and enable real-time risk stratification. Early implementation studies reveal improvements in adherence metrics and patient satisfaction, yet persistent challenges—such as network coverage, device charging, digital literacy and data privacy—must be addressed. As global health programmes seek scalable solutions, robust evidence on clinical effectiveness, cost-effectiveness and equitable access remains a priority.
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A meta-analysis of user and health-worker feedback found that digital adherence platforms were broadly acceptable, scoring high on capability, opportunity and motivation among people with tuberculosis and their supervisors. Technical obstacles—such as intermittent network coverage, device malfunction and intermittent electricity—were identified as key barriers, prompting recommendations to integrate support systems and minimise out-of-pocket costs for patients.
A scoping review of digital health interventions classified approaches into SMS reminders, electronic medicine monitors and web-based DOT. While most studies demonstrated improvements in treatment success rates and reduced missed doses, few addressed interactive, two-way communication or feedback loops. The review emphasised the need for bidirectional messaging to foster engagement and self-management.
A qualitative study of a low-cost mobile phone-based platform in Uganda highlighted both facilitators and obstacles to implementation. Patients and providers valued the simplicity and relationship-building aspects of the system, but barriers such as limited phone access, concerns over stigma, literacy challenges and gender-related disparities affected uptake. Tailored strategies were recommended to ensure inclusive adoption and sustained engagement.
Digital Technologies for Tuberculosis Treatment Adherence publication trend
The graph below shows the total number of articles in digital technologies for tuberculosis treatment adherence across all publications each year (not limited to Nature Index journals).
Technical terms
Digital adherence technology (DAT): digital tools and platforms designed to monitor and support patient medication-taking behaviour.
Directly observed therapy (DOT): traditional approach in which a healthcare worker or designated observer supervises each dose of medication intake.
Video-observed therapy (VOT): remote method of treatment supervision involving patients recording and transmitting videos of medication intake.
Short message service (SMS): text messaging system used to send reminders or prompts to patients via mobile phones.
mHealth: use of mobile and wireless technologies to deliver health interventions and services.
References
- Acceptability and feasibility of digital adherence technologies for drug-susceptible tuberculosis treatment supervision: A meta-analysis of implementation feedback. PLOS Digital Health (2023).
- Digital Health Interventions to Enhance Tuberculosis Treatment Adherence: Scoping Review. JMIR mHealth and uHealth (2023).
- Barriers and Facilitators to Implementing a Digital Adherence Technology for Tuberculosis Treatment Supervision in Uganda: Qualitative Study. Journal of Medical Internet Research (2023).
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