mHealth-supported tuberculosis contact investigation by community health workers in high-burden countries: a scoping review

Clinical Snapshot

Key Findings

• P Value: Not applicable for scoping review

• Effect Size: Not applicable for scoping review

• Primary Outcome: mHealth interventions for TB contact investigation by CHWs were generally perceived as acceptable and feasible

• Nnt Or Sensitivity: Implementation success depends on addressing multilevel barriers at individual, technology, and service system levels

• Confidence Interval: Not applicable for scoping review

Clinical Application

Feasible with adequate CHW training, reliable technology infrastructure, stakeholder support, and continuous monitoring systems Limited direct applicability to Australia given focus on high-burden countries, but principles may inform Indigenous health programs and remote area TB contact tracing initiatives Community health workers in high TB burden settings, particularly relevant for resource-limited countries with established CHW programs

Abstract

Mobile health (mHealth) implementation strategies in tuberculosis (TB) contact investigations are intended to increase community health workers' (CHWs) engagement in TB contact investigations and case detection. This scoping review aimed to map and synthesize existing evidence on the design and development of acceptable and feasible mHealth implementation strategies for CHW-led TB contact investigations. We conducted a scoping review following the Arksey and O'Malley framework and PRISMA-ScR guidelines. We searched PubMed, Scopus, Cochrane Library, Web of Science, and Google Scholar for English-language studies published through October 2024 on mHealth interventions for TB contact investigation by CHWs. Eligible studies included empirical studies conducted in high-burden countries (HBCs) for TB, HIV-associated TB, and MDR/RR-TB. Studies were screened, and data were extracted using Rayyan AI-assisted software. We mapped implementation strategies, barriers, facilitators, acceptability, and feasibility of mHealth interventions. Quantitative findings were described, and qualitative data were synthesized thematically. Nine studies were included. Most interventions used hybrid mHealth technologies for communication, case registration, health records, and decision support. Implementation strategies specified actors, actions, targets, temporality, dose, and justifications. Barriers were related to CHWs, digital systems, service implementation, and TB-affected persons. Facilitators included stakeholder support, CHW training, mHealth design, community engagement, and patient-centered approaches. Overall, CHWs perceived mHealth interventions as acceptable and feasible. Successful implementation in HBCs requires strengthened CHW capacity, reliable technology, optimizing interaction between CHWs and digital tools, and continuous monitoring and evaluation throughout implementation. Main findings: Health interventions for tuberculosis contact investigation by community health workers in three global lists of high-burden countries for tuberculosis, human immunodeficiency virus-associated tuberculosis, and multidrug-resistant/rifampicin-resistant tuberculosis are generally acceptable and feasible, but their effectiveness depends heavily on a clear implementation strategy and the ability to address multilevel barriers at the individual, technology, and service system levels.Added knowledge: Given the ongoing development of digital health interventions for TB contact investigation by community health workers, this review provides a novel contribution by systematically mapping seven dimensions of implementation strategies, classifying barriers and facilitators at multiple levels, and highlighting the importance of synergies between human actors and digital systems in determining implementation success.Global health impact for policy and action: These findings confirm that strategic integration of mHealth into national tuberculosis policies and programs – with sustained funding, community health worker capacity building, digital system interoperability, and implementation-based monitoring – is crucial for closing the contact investigation gap and accelerating the achievement of the global tuberculosis elimination target.

References

1. 1.Izhar, M. D., Wahab, A., Istiono, W., & Mahendradhata, Y. (2026). mHealth-supported tuberculosis contact investigation by community health workers in high-burden countries: a scoping review. Global Health Action, 19(1). https://doi.org/10.1080/16549716.2026.2684132