Effective mHealth Interventions to Improve Tuberculosis Treatment Adherence in Asia: A Systematic Review and Meta-Analysis

Background Tuberculosis (TB) has been one of the most common causes of mortality due to communicable diseases, with an estimated 1.25 million deaths in 2023 worldwide. In Asia, where most new TB cases are reported, treatment non-adherence is affected by complicated factors and practical challenges of implementing directly observed therapy (DOT). Mobile health (mHealth) tools bridge the provider-patient gap and may improve treatment adherence. We aim to systematically evaluate the impact of mHealth interventions compared to standard care on TB treatment adherence by synthesizing data from randomized controlled trials (RCTs) conducted in Asia. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies were eligible if they were RCTs conducted in an Asian country evaluating mHealth interventions against standard care. Authors searched seven databases, one search engine, and three grey literature sources, with no date or language restrictions. The primary outcome was treatment adherence, and secondary outcomes included type of intervention, income levels, frequency of communication, inclusion of educational component, complexity of technologies used, and the direction of communication. To explore sources of heterogeneity a pre-specified subgroup analyses was conducted. Pooled risk ratios were estimated using random-effects model; heterogeneity was assessed by I ² , and publication bias by Egger’s test and funnel plots. Results Authors screened 1427 articles, out of which ten trials involving 17,148 participants met the criteria for analysis. mHealth interventions improved treatment adherence compared to standard care (85.6% vs 83.2%; Risk Ratio (RR) 1.09, 95% Confidence Interval (CI) 1.02–1.16; p = 0.01; I² = 94%). Subgroup analysis indicated increased adherence with bidirectional communication (4.9%), daily reminders (7.2%), the inclusion of an educational component (2.7%), and the use of combination technology (13.2%). No significant publication bias was detected (Egger’s p = 0.375). Conclusion mHealth intervention yields a small but meaningful improvement in treatment adherence in Asian settings. Even 2.4% increase in adherence in Asian countries, where TB is a significant burden, could lead to thousands getting cured, decreased relapse rates, fewer drug resistance cases, and decreased transmissions.