Submission ID 132027
| Issue/Objective | Tuberculosis (TB) remains a major public health issue in Pakistan, one of the top five highest TB burden countries globally. Despite available diagnostic tools and treatment, gaps in timely diagnosis, treatment adherence, and follow-up continue to hinder TB control and are worsened by a fragmented public-private healthcare system. Digital and mobile health (mHealth) interventions have emerged as promising tools to strengthen the TB care cascade; however, evidence on their implementation, effectiveness, and integration within Pakistan's health system remains limited. This review aimed to: (1) identify TB care cascade stages targeted by digital interventions in Pakistan, (2) examine implementation barriers and facilitators affecting scale-up, and (3) identify evidence gaps and priorities to improve the design and integration of digital technologies to strengthen continuity of TB care. |
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| Methodology/Approach | A qualitative document review was conducted using the READ (Review, Extract, Analyze, Distill) framework. A total of 319 sources (317 peer-reviewed and 2 gray literature) published between January 2012 and February 2026 were screened, with 9 meeting inclusion criteria. Data were thematically analyzed using NVivo to categorize intervention types, outcomes, and key implementation barriers and facilitators. Findings were synthesized to inform digital health planning and policy development for Pakistan's TB care system. |
| Results | Four categories of TB digital interventions were identified: mobile applications, health information systems, digital data collection tools, and SMS-based technologies. Most interventions targeted multiple cascade stages (screening, testing, diagnosis, and treatment), while none addressed post-treatment follow-up. Mobile applications and digital data tools improved screening uptake and treatment completion. Health information systems enhanced data quality, surveillance, and reporting efficiency, while SMS-based interventions showed limited impact on treatment adherence. Key barriers included infrastructural limitations, limited digital literacy, workforce constraints, workflow inefficiencies, data quality issues, and financial sustainability challenges. Facilitators included support from NGOs and technical partners, improved data systems, and coordination with national TB programs. |
| Discussion/Conclusion | Digital technologies show strong potential to strengthen Pakistan's TB care cascade, particularly in screening, data management, and treatment monitoring. However, systemic and implementation barriers limit their impact. Scaling effective digital tools will require interoperable systems, strengthened health system capacity, and context-specific, sustainable strategies to advance TB control goals. |
| Presenters and Affiliations | Saad Ahmed University of Waterloo, School of Public Health Sciences Charity Oga-Omenka University of Waterloo, School of Public Health Sciences |
