Overcoming structural barriersto tuberculosistreatment in Africa through digital technologies

Abstract

Millions of people still die from tuberculosis in Africa. The continent is home to 17 of the 30 countries with the highest tuberculosis burdens and 25% of all new cases worldwide. According to the WHO Global Tuberculosis Report 2025,1 the continent exceeded the first End TB Strategy milestones and recorded one of the strongest global recoveries in tuberculosis control; the efforts of African governments and their international partners have been instrumental in this progress. Despite these advances, the continent is still struggling with monitoring tuberculosis treatment adherence and completion, which directly affects cure, relapse, drug resistance, transmission dynamics, and economic wellbeing. In this Comment, we argue that evaluation of tuberculosis treatment adherence strategies in Africa, particularly digital adherence technologies (DATs), need to extend beyond biomedical treatment outcomes to include patient-centred, economic, health system, and transmission-related effects