Barriers and facilitators to the implementation of electronic monitors to improve adherence and health outcomes in patients with tuberculosis: a systematic review

Tuberculosis remains a public health concern, and electronic monitors show promise in improving treatment adherence and health outcomes among patients with tuberculosis. This Review aims to provide a comprehensive understanding of the implementation barriers and facilitators of electronic monitors for patients with tuberculosis, by use of an implementation science framework. A literature search was done across Ovid MEDLINE, CINAHL, Embase, Cochrane Library, Web of Science, and Global Health databases from their inception to April 25, 2024. Studies reporting on the barriers and facilitators of electronic monitors among patients with tuberculosis were included and study characteristics and evidence were tabulated. Implementation factors were synthesised applying the updated Consolidated Framework for Implementation Research framework. This Review was registered with PROSPERO (CRD42023395747). Of 8816 records, 31 eligible studies were included. Barriers mainly included the information technology infrastructure, materials, and equipment resources, whereas facilitators included access to knowledge and information, communications, and reflecting and evaluating. Innovation design and patients' motivation were identified as both common barriers and facilitators. Inter-relationships between these factors were also explored. Cooperative and patient-centred efforts are required to address the barriers identified. Specific recommendations include improving education and training, eliminating stigma, and resolving technical challenges with feedback to boost patients' treatment adherence and outcomes.