A Narrative Review of the Impact of Telemedicine on Direct Observed Therapy in Tuberculosis

Abstract

Tuberculosis (TB) remains a major public health challenge, particularly in low- and middle-income countries (LMICs), where conventional directly observed therapy (DOT) places substantial logistical and resource demands on patients and health systems. Telemedicine, particularly video-observed therapy (VOT), has been increasingly adopted to support tuberculosis treatment supervision; however, existing evidence remains fragmented and insufficiently synthesised from a health system and management perspective. This narrative review synthesised peer-reviewed evidence published between 2013 and 2024 on telemedicine-enhanced DOT for tuberculosis, with a focus on treatment adherence, cost and resource implications, patient acceptability, scalability, and equity across diverse health system contexts. Across study designs and settings, telemedicine-enhanced supervision achieved treatment adherence and completion outcomes comparable to, or exceeding, conventional facility-based DOT. Asynchronous and hybrid VOT models demonstrated advantages in reducing patient burden, improving workforce efficiency, and supporting programme scalability. Economic evaluations indicated consistent cost savings for patients and health systems, while qualitative evidence highlighted high patient acceptability, including increased autonomy and reduced stigma. However, persistent digital inequities related to device access, connectivity, and digital literacy limited universal applicability. Overall, telemedicine-enhanced DOT appears most effective when implemented as a complementary component of differentiated tuberculosis care rather than as a uniform replacement for conventional supervision. This review provides policy-relevant insights for health system leaders and programme managers on the strategic integration of telemedicine to balance effectiveness, efficiency, scalability, and equity in contemporary TB care.