Digital Technologies and Health Inequalities in Tuberculosis Care: An Analysis of Institutional Processes in the Implementation of Video Directly Observed Therapy with a Focus on Equity and Health System Sustainability
1
University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
2
State University of Western Paraná, Foz do Iguaçu, Paraná, Brazil, Foz do Iguaçu, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A911
ABSTRACT
INTRODUCTION:
Tuberculosis (TB) remains a major public health challenge in Brazil, strongly associated with social and structural inequalities affecting diagnosis, continuity of care, and treatment adherence, particularly in Primary Health Care (PHC). Digital health technologies, such as Video Directly Observed Therapy (vDOT), can expand and flexibilize care, optimize supervision, and reduce costs. However, social and digital inequities limit access and adherence, requiring complex institutional processes, including workflow reorganization, technological infrastructure, governance, interinstitutional coordination, and workforce training.
OBJECTIVE:
To analyze the institutional processes involved in adopting digital technologies for TB care, emphasizing equity, inclusion, sustainability, and health system resilience.
METHODS:
An analytical study was conducted in eight municipalities in São Paulo, Brazil, integrating observation of institutional processes related to vDOT implementation and interviews with patients, health managers, and professionals. The analysis focused on implementation, care workflow reorganization, institutional agreements, intersectoral negotiation, training, technological infrastructure, and digital access.
RESULTS:
vDOT implementation revealed complex institutional and operational barriers, requiring interinstitutional coordination and negotiation across multiple management levels. TB had low prioritization, associated with limited awareness among managers and professionals. Inequities in digital devices, connectivity, and literacy negatively impacted adherence. Successful strategies included strengthening patient-provider relationships, integrating PHC and local management, targeted training, and contextualized technology adaptation, contributing to resilience, sustainability, and local governance strengthening.
CONCLUSIONS:
vDOT can reinforce PHC and improve TB treatment adherence; however, its effectiveness depends on institutional context, governance, infrastructure, integration across care levels, and qualified teams. Ensuring TB prioritization, reaching vulnerable populations, and minimizing treatment interruptions require comprehensive institutional and systemic support.
Tuberculosis (TB) remains a major public health challenge in Brazil, strongly associated with social and structural inequalities affecting diagnosis, continuity of care, and treatment adherence, particularly in Primary Health Care (PHC). Digital health technologies, such as Video Directly Observed Therapy (vDOT), can expand and flexibilize care, optimize supervision, and reduce costs. However, social and digital inequities limit access and adherence, requiring complex institutional processes, including workflow reorganization, technological infrastructure, governance, interinstitutional coordination, and workforce training.
OBJECTIVE:
To analyze the institutional processes involved in adopting digital technologies for TB care, emphasizing equity, inclusion, sustainability, and health system resilience.
METHODS:
An analytical study was conducted in eight municipalities in São Paulo, Brazil, integrating observation of institutional processes related to vDOT implementation and interviews with patients, health managers, and professionals. The analysis focused on implementation, care workflow reorganization, institutional agreements, intersectoral negotiation, training, technological infrastructure, and digital access.
RESULTS:
vDOT implementation revealed complex institutional and operational barriers, requiring interinstitutional coordination and negotiation across multiple management levels. TB had low prioritization, associated with limited awareness among managers and professionals. Inequities in digital devices, connectivity, and literacy negatively impacted adherence. Successful strategies included strengthening patient-provider relationships, integrating PHC and local management, targeted training, and contextualized technology adaptation, contributing to resilience, sustainability, and local governance strengthening.
CONCLUSIONS:
vDOT can reinforce PHC and improve TB treatment adherence; however, its effectiveness depends on institutional context, governance, infrastructure, integration across care levels, and qualified teams. Ensuring TB prioritization, reaching vulnerable populations, and minimizing treatment interruptions require comprehensive institutional and systemic support.
| eISSN: | 2654-1459 |
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