Effectiveness, Acceptability and Challenges of Medication Event Reminder Monitors in Tuberculosis Care: A Systematic Review

Abstract Introduction: Poor adherence to tuberculosis (TB) treatment, both drug-susceptible and drug-resistant, contributes to unfavourable outcomes and drug resistance. Digital adherence technologies (DATs), including medication event reminder monitors (MERM), have emerged as promising tools to support adherence. Materials and Methods: A systematic review was conducted to assess the impact of MERM on medication adherence, clinical outcomes and satisfaction amongst TB patients and healthcare providers. Studies published up to 16 February 2023 were screened across PubMed, ScienceDirect, DOAJ, Embase and Web of Science. Eligible studies included clinical trials, observational and qualitative designs. Risk of bias was assessed using the Cochrane tool for randomised controlled trials and the Newcastle–Ottawa Scale for observational studies. Results: Eight studies were included (3 trials, 4 prospective and 1 cross-sectional) with 76,811 participants. MERM was found to improve adherence and treatment outcomes. Influencing factors included age, gender, human immunodeficiency virus status, diagnosis type and patient setting. Conclusion: MERM appears effective and acceptable in TB care, although patient experiences vary. Additional research is needed to optimise DATs and tailor strategies for high-burden settings.