BMC public health · 2026
Effective mHealth interventions to improve tuberculosis treatment adherence in Asia: a systematic review and meta-analysis.
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Kankawale Shamal, Chutke Amruta, Kaur Navpreet
Аннотация
BACKGROUND: In Asia, where most new tuberculosis cases are reported, mobile health (mHealth) tools may improve treatment adherence and address practical difficulties in implementing directly observed therapy (DOT). We aim to systematically evaluate the impact of mHealth interventions on TB treatment adherence compared with standard care by synthesizing data from randomized controlled trials (RCTs) conducted in Asia.
METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies were eligible if they were RCTs conducted in an Asian country with adult participants aged 18 years or older that evaluated mHealth interventions against standard care. Authors searched PubMed, ScienceDirect, Directory of Open Access Journals, Cochrane Central Register of Controlled Trials, Ovid, and the Clinical Trials registry of the United States National Library of Medicine (US NLM), along with Google Scholar and three grey literature sources, namely Medrxiv, Psyxiv, and Shodhganga, from inception to March 2024, with no date or language restrictions. The primary objective was treatment adherence, and secondary objectives were to identify factors contributing to differences in effectiveness, including definition of treatment adherence, intervention type, country income classification, reminder frequency, educational content, technological complexities, and the direction of communication. To explore sources of heterogeneity, pre-specified subgroup analyses were conducted. Pooled risk ratios were estimated using a random-effects model; heterogeneity was assessed by I2, and publication bias by Egger’s test and funnel plots.
RESULTS: Authors screened 1427 articles, out of which ten trials involving 17,148 participants met the criteria for analysis. Meta-analysis showed that mHealth interventions improved treatment adherence compared to standard care (85.6% vs. 83.2%; Risk Ratio (RR) 1.09, 95% Confidence Interval (CI) 1.02–1.16; p = 0.01; I² = 94%). Subgroup meta-analyses indicated greater adherence with bidirectional communication, daily reminders, an educational component, and combination technology. A significant effect was observed in studies measuring dose-level adherence, whereas findings based on treatment outcomes were not statistically significant and showed substantial heterogeneity. No significant publication bias was detected (Egger’s p = 0.375).
CONCLUSION: mHealth intervention may offer a small but meaningful improvement in treatment adherence in Asian settings. Even a 2.4% increase in adherence in Asian countries, where TB is a significant burden, could lead to thousands getting cured, decreased relapse rates, fewer drug resistant cases, and decreased transmissions.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-026-27448-4.
METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies were eligible if they were RCTs conducted in an Asian country with adult participants aged 18 years or older that evaluated mHealth interventions against standard care. Authors searched PubMed, ScienceDirect, Directory of Open Access Journals, Cochrane Central Register of Controlled Trials, Ovid, and the Clinical Trials registry of the United States National Library of Medicine (US NLM), along with Google Scholar and three grey literature sources, namely Medrxiv, Psyxiv, and Shodhganga, from inception to March 2024, with no date or language restrictions. The primary objective was treatment adherence, and secondary objectives were to identify factors contributing to differences in effectiveness, including definition of treatment adherence, intervention type, country income classification, reminder frequency, educational content, technological complexities, and the direction of communication. To explore sources of heterogeneity, pre-specified subgroup analyses were conducted. Pooled risk ratios were estimated using a random-effects model; heterogeneity was assessed by I2, and publication bias by Egger’s test and funnel plots.
RESULTS: Authors screened 1427 articles, out of which ten trials involving 17,148 participants met the criteria for analysis. Meta-analysis showed that mHealth interventions improved treatment adherence compared to standard care (85.6% vs. 83.2%; Risk Ratio (RR) 1.09, 95% Confidence Interval (CI) 1.02–1.16; p = 0.01; I² = 94%). Subgroup meta-analyses indicated greater adherence with bidirectional communication, daily reminders, an educational component, and combination technology. A significant effect was observed in studies measuring dose-level adherence, whereas findings based on treatment outcomes were not statistically significant and showed substantial heterogeneity. No significant publication bias was detected (Egger’s p = 0.375).
CONCLUSION: mHealth intervention may offer a small but meaningful improvement in treatment adherence in Asian settings. Even a 2.4% increase in adherence in Asian countries, where TB is a significant burden, could lead to thousands getting cured, decreased relapse rates, fewer drug resistant cases, and decreased transmissions.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-026-27448-4.