Profiling digital technologies used to support the tuberculosis care cascade and their implementation across high burden countries: A systematic scoping review

Digital technologies, such as mHealth interventions and integrated data management tools, are increasingly being developed and implemented to support patients and health care providers in low-resource, high tuberculosis (TB)-burden countries in initiating and proceeding through the TB care cascade (e.g., screening, testing, diagnosis, treatment). Yet, given the proliferation of these tools, there exists a need to synthesize what technologies are being used and where, as well as build a comprehensive understanding of their respective functionality and implementation considerations. The objectives of this systematic scoping review were: (1) to systematically identify literature on digital technologies for supporting the TB cascade in high TB-burden countries; and (2) to describe the facilitators and barriers to technology implementation. Four databases were systematically searched for published literature using a search hedge of terms related to TB, technology, and implementation. Two independent reviewers conducted screening of retrieved literature, data extraction, and data analysis. Eighteen digital technologies were identified, with 10 classified as backbone technologies and eight as add-in technologies. Three key implementation domains were identified: (1) Interoperability and Integration, (2) Digital Infrastructure, and (3) User Experience. Backbone technologies showed higher integration rates with National TB Programs and were more likely to be sustainably implemented. Key barriers to technology implementation included connectivity issues, inadequate user training, and complex multistakeholder integration processes. Included sources described how implementation success was influenced by the interplay between systems-level, technology-level, and user-level factors. Future research should prioritize implementation science approaches to facilitate technology adoption and use to support the TB care cascade.