Box 12. Illustrative research questions for a connected TB diagnostics platform (programme management)

RE-AIM domain	Illustrative research questions
Reach	What proportion of TB diagnoses are represented within the connected platform? What proportion of basic medical units (BMUs) are contributing to the system? Are there any differences between cases that are and are not captured within the system, or between BMUs that are and are not utilising the connected platform? What could be done to get more of the intended beneficiaries to begin using, be registered using, or receive actionable information using the technology? What strategies or approaches are needed to/are effective in increasing utilization of the connected platform by reporting and/or diagnostic units? (consider additional training, instruction manuals, changes to the user interface etc).
Effectiveness	Has introduction of the connected diagnostic platform led to improvements in key programme performance indicators (such as time from diagnosis to treatment initiation, or reductions in pre-treatment loss to follow up for example) compared to when de-centralized systems were used? What is the cost-effectiveness of implementing and utilizing the connected diagnostic platform under programmatic conditions compared with previous paper-based/unlinked reporting systems? Are there any unintended or negative impacts related to implementation or utilization of the connected diagnostic platform? (such as changes in workload or staffing requirements) What end-user and health system factors facilitated or were barriers to successfully using the connected diagnostic platform?
Adoption	What proportion of reporting and diagnostic units are connected to the platform? Are there any differences in characteristics between systems that are and are not connected? What proportion of reporting units/users (depending on level of intervention) in the public and private sector are linked to the connected diagnostic platform and how has this proportion changed over time? Are there geographic, health sector or other differences between target settings/users that are connected to, and using the platform compared with those that are not? What factors contributed to the decision of target reporting units to start using the connected diagnostic platform? What are the facilitators/motivational factors/barriers and perceived challenges to use, benefits, acceptance, satisfaction? Are there infrastructural constraints?
Implementation	Are there certain patient groups whose data are eminently missing from the connected diagnostic platform (e.g. TB/HIV or MDR-TB)? What proportion of users stop using the technology after starting? What are the costs/savings and infrastructural requirements associated with the technology? What is the proportion of evaluated functionalities with correct functioning/needing adjustment/with bugs to be fixed at time of evaluation? What are the key barriers and facilitators to implementation and use of the connected diagnostics platform as intended? Consider capability (e.g. knowledge, technical skills, language), opportunity (e.g. time, cost, infrastructure limitations, policies, social norms), and motivation (e.g. beliefs, habits) factors. What are the main policy, regulatory or other operational (e.g. HR, finance) barriers and facilitators to scalability?
Maintenance	What proportion of target settings and end-users continues to use the platform after the initial roll-out (e.g. after 12 months and 24 months)? Do key programme indicators differ across settings that do and do not continue to use the platform? What are the costs and infrastructure requirements associated with continued use of the platform? What is the cost to maintain the platform (e.g. licensing, upgrades, additional features/developer time) on an annual basis and how have costs varied over time?