Comparative Effectiveness of Digital Health Technologies in Tuberculosis Treatment: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Background: Tuberculosis (TB) treatment remains a critical global health challenge, as traditional standard of care (SoC) approaches face limitations in accessibility and efficacy. While digital health technologies (DHTs) offer promising solutions to address these gaps, limited evidence exists on their comparative effectiveness.

Objective: This study systematically evaluates and compares the impact of diverse DHTs on improving TB treatment outcomes and adherence, aiming to identify optimal strategies across different patient populations.

Methods: A systematic search was conducted across PubMed, Cochrane Library, Embase, and Web of Science from database inception through February 28, 2025, with no language restrictions. Eligible studies included randomized controlled trials comparing DHTs with SoC for TB treatment. The primary outcome was treatment success, defined as completion or cure. A random-effects network meta-analysis was performed, calculating odds ratios (OR) and 95% credibility intervals (CrI) to assess treatment effects. Surface under the cumulative ranking curve (SUCRA) values were used to rank intervention effectiveness. This study is registered with PROSPERO (International Prospective Register of Systematic Reviews; CRD42025601199).

Results: From 2420 screened studies, 27 randomized controlled trials involving 23,283 patients and eight DHT interventions were included. The network meta-analysis revealed that digital health platforms showed marginal improvements in treatment success (OR=3.44; 95% CrI 0.95-11.67; SUCRA=0.913; P=.05). Compared with SoC, video directly observed treatment (VDOT) significantly improved treatment success (OR=2.39; 95% CrI 1.18-4.75; SUCRA=0.848; P=.01). Medication event reminder monitors significantly enhanced treatment adherence (OR=3.13; 95% CrI 1.55-7.05; SUCRA=0.891; P=.003).

Conclusions: Results underscore the significant potential of DHTs to improve TB treatment management. VDOT emerged as the most effective intervention for enhancing treatment success, while medication event reminder monitors demonstrated efficacy in sustaining adherence. Digital health platforms showed promise but require additional validation. Caution is warranted due to potential heterogeneity across studies, which may affect generalizability. This research offers actionable insights for stakeholders aiming to optimize TB management through strategic DHT integration.