Implementing digital health innovations for tuberculosis treatment in real-world settings: operational insights from São Paulo state, Brazil
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1. Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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2. Regional Health Department XIII, São Paulo State Department of Health, Ribeirão Preto, São Paulo, Brazil
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3. Foz do Iguaçu Campus, State University of Western Paraná, Foz do Iguaçu, Paraná, Brazil
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4. Maria Auxiliadora Campus, Salesian University Center of São Paulo, Americana, São Paulo, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A935
ABSTRACT
BACKGROUND:
Tuberculosis (TB) treatment adherence remains challenging, particularly in settings with high social vulnerability and limited health system capacity. Digital health technologies, such as Video Directly Observed Therapy (vDOT), have been recommended by the World Health Organization and the Brazilian Ministry of Health as patient-centered strategies for treatment supervision while reducing patient and service burdens. Despite favorable evidence, implementing vDOT in decentralized health systems remains challenging. This study aimed to analyze key operational barriers and facilitators to implement vDOT in municipalities in São Paulo state, Brazil.
METHODS:
This pragmatic implementation study was conducted between October 2024 and January 2026 in 15 municipalities. vDOT implementation was assessed in local healthcare systems across sequential stages: municipal recruitment, formal institutional agreement, planning, workforce training, system deployment, and continuous monitoring and technical support. Periodic meetings with health managers were conducted to monitor progress, identify barriers, and adapt implementation strategies. Quantitative implementation indicators were obtained from monitoring records and the vDOT platform, and qualitative data were gathered from health professionals’ feedback and meeting reports.
RESULTS:
Most municipalities (73.3%, n=11) initiated vDOT, while 4 (26.7%) remained under negotiation. vDOT was integrated into 166 health services, 289 professionals were trained, and 40 TB treatments were supervised. Implementation indicators varied substantially across municipalities regarding adoption, timelines, training coverage, and system use. Moreover, monitoring showed that heterogeneity was mainly associated with differences in health system organization, local decision-making processes, workforce availability, digital infrastructure, and adaptive strategies adopted during implementation.
CONCLUSIONS:
vDOT implementation revealed substantial operational challenges related to health system capacity, governance, and digital implementation readiness. Despite these constraints, the strategy proved feasible across diverse municipal contexts when supported by adaptive planning, workforce training, and sustained institutional engagement. These findings underscore the critical role of adaptive implementation strategies in enabling scalable, equitable, and sustainable digital innovations for TB control.
Tuberculosis (TB) treatment adherence remains challenging, particularly in settings with high social vulnerability and limited health system capacity. Digital health technologies, such as Video Directly Observed Therapy (vDOT), have been recommended by the World Health Organization and the Brazilian Ministry of Health as patient-centered strategies for treatment supervision while reducing patient and service burdens. Despite favorable evidence, implementing vDOT in decentralized health systems remains challenging. This study aimed to analyze key operational barriers and facilitators to implement vDOT in municipalities in São Paulo state, Brazil.
METHODS:
This pragmatic implementation study was conducted between October 2024 and January 2026 in 15 municipalities. vDOT implementation was assessed in local healthcare systems across sequential stages: municipal recruitment, formal institutional agreement, planning, workforce training, system deployment, and continuous monitoring and technical support. Periodic meetings with health managers were conducted to monitor progress, identify barriers, and adapt implementation strategies. Quantitative implementation indicators were obtained from monitoring records and the vDOT platform, and qualitative data were gathered from health professionals’ feedback and meeting reports.
RESULTS:
Most municipalities (73.3%, n=11) initiated vDOT, while 4 (26.7%) remained under negotiation. vDOT was integrated into 166 health services, 289 professionals were trained, and 40 TB treatments were supervised. Implementation indicators varied substantially across municipalities regarding adoption, timelines, training coverage, and system use. Moreover, monitoring showed that heterogeneity was mainly associated with differences in health system organization, local decision-making processes, workforce availability, digital infrastructure, and adaptive strategies adopted during implementation.
CONCLUSIONS:
vDOT implementation revealed substantial operational challenges related to health system capacity, governance, and digital implementation readiness. Despite these constraints, the strategy proved feasible across diverse municipal contexts when supported by adaptive planning, workforce training, and sustained institutional engagement. These findings underscore the critical role of adaptive implementation strategies in enabling scalable, equitable, and sustainable digital innovations for TB control.
| eISSN: | 2654-1459 |
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