# Transitioning to a digital TB case-based surveillance system: a mixed-methods study of the DHIS2 TB e-Tracker system

## TL;DR

This study evaluates the implementation of an electronic TB surveillance system in The Gambia, finding it promising but requiring infrastructure and training support for success.

## Contribution

The study provides insights into the challenges and benefits of transitioning to a digital TB surveillance system in a real-world setting.

## Key findings

- High concordance between e-Tracker and aggregate reports at the national level, but lower accuracy at the facility level.
- Most users understood case-based surveillance, but routine use for patient management was limited due to infrastructure and training issues.
- Participants reported improved efficiency and optimism about the e-Tracker system despite implementation barriers.

## Abstract

TB surveillance remains critical to disease control. The Gambia transitioned to an electronic, case-based surveillance from monthly aggregate reporting. This study assessed the knowledge, attitudes, practices, data accuracy, concordance, and system usability following the e-Tracker pilot.

A mixed-methods study was conducted across 11 sites over 6 months. Quantitative data were collected from the District Health Information System 2 aggregate and e-Tracker to calculate verification factor and concordance of data, and in-depth interviews were conducted to understand perceptions, usability challenges, and implementation barriers. Data were analysed using descriptive statistics and thematic analysis.

Over two thirds of users demonstrated understanding of case-based surveillance. Overall concordance between reports and e-Tracker at the national level was high, and lower accuracy was observed at the facility. While the e-Tracker enabled richer data capture for key indicators, routine use for patient management was limited. Key barriers included inadequate infrastructure, staff turnover, dependence on single users, and variable digital literacy. Most participants reported improved efficiency and optimism.

The e-Tracker shows promise for strengthening TB surveillance. To realise its impact, scale-up must capture infrastructure, capacity building, and inputs from frontline staff to ensure sustainability. The study is limited by reliance on self-reported experiences and absence of long-term outcome data.