The role of digital health interventions for adults with tuberculosis: a network meta-analysis of randomized controlled trials

Background Incomplete adherence to tuberculosis treatment increases the risk of delayed sputum culture conversion in the community, as well as elevated risks of treatment failure, recurrence, and the development or amplification of drug resistance. Through network meta-analysis, we aimed to comprehensively analyze the effects of digital health interventions for patients with tuberculosis. Methods PubMed, Cochrane Library, Embase and Web of Science for randomized controlled trails that examined the efficacy of digital health intervention for tuberculosis treatment up to 18 May 2026. The main outcome included treatment success and adherence. Stata (version 17) and R software (version 4.3.1) were used for the data analysis. Results From 17,643 publications, we included 29 randomized controlled trials involving 17,800 participants for quantitative analysis. Overall, digital health interventions showed a statistically higher treatment success rate than directly observed therapy (RR 1.03; 95% CI 1.00–1.07). Then a network meta-analysis of each intervention was conducted. Regarding treatment success, apart from video observed therapy showing significantly better outcomes compared to directly observed therapy (RR 1.18; 95% CI 1.02–1.37) and double-way short message service (RR 0.80; 95% CI 0.67–0.95), there was no statistically significant difference observed between medication event reminder monitor systems, monitors, single-way short message services, double-way short message service, video observed therapy, phone calls, and directly observed therapy. In terms of adherence, video observed therapy also demonstrated significantly higher adherence rates compared to other interventions. Additionally, video observed therapy was ranked as the top digital health intervention for achieving both treatment success and adherence. Conclusion Video observed therapy has excellent effects on treatment success and adherence than other digital health interventions. Given its excellent efficacy, video observed therapy should be given more prominence in clinical care, especially for individuals with low adherence, where resources allow.