Policy Challenges and Structural Barriers to Digital Transformation in Tuberculosis Control in Low- and Middle-Income Countries: A Systematic Review

Vollständiger Abstract

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Digital transformation can strengthen tuberculosis control through adherence monitoring, patient–health worker communication, recordkeeping, and service follow-up. However, its implementation in low- and middle-income countries (LMICs) continues to face policy challenges and structural barriers. This systematic review aimed to identify policy challenges, structural barriers, and strategies supporting digital transformation in tuberculosis control in LMICs. The review followed PRISMA 2020 and was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261377489). We searched PubMed, Scopus, ScienceDirect, and Springer Nature Link for peer-reviewed articles published between 2015 and 2025. The database searches initially displayed 859 records, of which 809 were successfully exported and imported into Mendeley. After removing 19 initial duplicates, we screened 790 records using the SPIDER framework. We assessed methodological quality using the JBI Critical Appraisal Checklist for Qualitative Research. Nineteen studies met the inclusion criteria and were thematically analyzed. Policy challenges involved regulation and data governance, policy communication, coordination across sectors and levels of care, and digital program integration. Structural barriers included limitations in the health workforce, technological infrastructure, financing, digital access and equity, health information systems, and service delivery. Recommended strategies comprised stronger regulation, system integration, sustainable financing, workforce development, patient-centered approaches, and monitoring and evaluation. Digital transformation in tuberculosis control requires an integrated, secure, sustainable, equitable, and context-responsive health system. Stakeholders should prioritize data protection, interoperability, sustainable financing, continuous training, and non-digital service options to prevent technology from widening inequalities in access.