Transitioning to a TB case-based surveillance system: Knowledge, Attitude, Practice, Data Accuracy and Concordance study of the DHIS2 TB e-Tracker in The Gambia

Background Tuberculosis (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.Methods A mixed-methods study was conducted across 11 sites over six months. Quantitative data were collected from the DHIS2 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.Results Over two-thirds of users demonstrated understanding of case-based surveillance. Overall concordance between reports and e-Tracker at the national level was high, 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.Conclusion: The e-Tracker shows promise for strengthening TB surveillance. To realise its impact, scale-up must capture infrastructure, capacity building, inputs from frontline staff to ensure sustainability. The study is limited by reliance on self-reported experiences and absence of long-term outcome data.