Evaluation methods in tuberculosis control programs in resource-limited settings: a scoping review

Background Tuberculosis (TB) remains one of the leading causes of morbidity and mortality globally, disproportionately affecting resource-limited settings (RLSs). Despite increased investments in TB programs, significant gaps persist in the evaluation process. Objectives This scoping review aimed to: explore the types of evaluation frameworks and methods used, assess implementation level and evaluations, and identify gaps in TB program evaluation across RLSs. Methods Following the PRISMA-ScR guidelines, a structured search was conducted across five electronic data bases and grey literature sources. Studies evaluating TB programs effectiveness, implementation, equity, or sustainability in RLSs were included. Data was charted using a standard form and synthesized thematically. Results Of 78 included studies, most evaluations were conducted in Sub-Saharan Africa (41%) and South Asia (23%). Quantitative methods were the most employed (31%), followed by mixed methods (24%). Gaps emerged in three key areas: only 21% of studies applied a multidimensional equity lens, just 9% assessed sustainability while stakeholder engagement was reported in 61,5% of the studies, involvement of community members (35%) or policymakers (12%) was limited. Conclusion Evaluations in RLSs are limited in scope and methodology. Future evaluations should adopt context sensitive methodologies, that are embedded in equity metrics, and promote inclusive stakeholder participation to guide more effective and sustainable TB control strategies.