Enhancing tuberculosis care in lower and middle-income countries through digital adherence technologies.

Tuberculosis (TB) remains a major public health challenge, particularly in low- and middle-income countries (LMICs), with treatment adherence being a critical issue. In recent years, digital adherence technologies (DATs) have emerged as a promising approach to enhance TB care and treatment adherence in these settings. Despite their potential to enhance treatment outcomes, their implementation faces challenges, including infrastructure demands, costs, and variability in effectiveness depending on the context. A critical aspect of DATs is their cost-effectiveness, which has shown mixed results across different LMICs. Some technologies, such as the medication sleeves/labels (, 99DOTS), demonstrate low-cost alternatives to traditional directly observed therapy (DOT), while others report inconsistent outcomes. Throughout its implementation, DATs can be a source of intervention-generated inequality, where they may disproportionately benefit low-risk populations with better access to technology, potentially widening gaps in healthcare equity. However, when targeted effectively at high-risk groups, DATs can promote equitable health outcomes and enhance TB care delivery. The successful implementation of DATs requires context-specific strategies that address the unique challenges of LMICs, such as technology fatigue, data privacy, and the need for tailored interventions that consider socioeconomic and cultural factors. Leveraging the support of global health initiatives and collaborative funding mechanisms could help scale up DAT adoption and contribute to the global goal of TB elimination.