Digital Health Interventions to Improve Adherence in Patients with Latent Tuberculosis: a Systematic Review and Meta-Analysis (Preprint)

<sec> <title>BACKGROUND</title> The poor adherence has been one of the barriers to the success of prophylactic treatment in latent tuberculosis (LTBI) patients, as well as an obstacle to tuberculosis prevention and elimination. Digital health interventions have offered a promising solution to low and nonadherence of LTBI treatment. </sec> <sec> <title>OBJECTIVE</title> This systematic review and meta-analysis aims to evaluate the effect of digital health interventions on treatment adherence of latent tuberculosis treatment. We focus on the effects of different digital health interventions on LTBI treatment completion and clinic outcomes compared with traditional supervision. </sec> <sec> <title>METHODS</title> A literature search in seven databases and gray database was conducted. Both randomized controlled trails (RCTs) and observational studies that evaluating treatment completion or adherence of digital interventions for latent tuberculosis treatment were included. Outcomes were measured as odd ratio (OR) with 95% confidence intervals. RoB1 approach was used for quality assessment of RCTs and ROBINS-I approach was used for quality assessment of observational studies. </sec> <sec> <title>RESULTS</title> Overall, 3 RCTs,18 observational studies and 10 clinic trails meet the inclusion criteria were analyzed. Among the included studies, 6 studies are for remote supervision (message or telephone reminders), 8 studies are for direct supervision (directly observed therapy and video observed therapy), and 18 studies are for online supervision (electronic medicine box, telephone application and WeChat supervision). In general, digital health interventions can improve treatment completion (OR:1.36, 95%CI 1.18-1.57) and regular medicine-taking (OR:5.39, 95%CI 2.28-10.10) when compared with standard supervision, but the effect varies according to the intervention (online supervision: OR:1.67, 95%CI 1.46-1.92, remote and/or direct supervision: OR:2.06, 95%CI 1.74-2.42) Remote supervision is associated with better completion compared with standard supervision (OR:1.37, 95%CI 2.28-1.57). Direct supervision has positive effect on adherence when compared with standard supervision (OR:8.66, 95%CI 2.77-27.05). Among all online intervention, Telephone application and WeChat supervision have shown evidence of improving adherence (OR:1.37, 95%CI 1.15-1.63) when compared with electronic medicine box. </sec> <sec> <title>CONCLUSIONS</title> It was found that digital health interventions can improve treatment adherence of LTBI treatment. However, the effect of improving adherence and clinic outcomes varies in the type of interventions. When choosing proper interventions, factors like type of intervention, time of the regime, cost and efficiency, facilities and patients satisfaction should also be considered. </sec> <sec> <title>CLINICALTRIAL</title> This study is prospectively registered in PROSPERO (ID: CRD420251007138) </sec>