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Computer-aided diagnostic interventions have been developed to address this gap and their successful implementation depends on many health systems factors. A socio-technical system to implement a computer-aided diagnostic tuberculosis diagnosis was preliminary tested in five primary health centers located in Lima, Peru. We recruited nurses (n\u2009=\u20097) and tuberculosis physicians (n\u2009=\u20095) from these health centers to participate in a field trial of an mHealth tool (eRx X-ray diagnostic app). From September 2018 to February 2019, the nurses uploaded images of chest X-rays using smartphones and the physicians reviewed those images on web-based platforms using tablets. Both completed weekly written feedback about their experience. Each nurse participated for a median duration of 12\u2009weeks (interquartile range\u2009=\u20097.5\u201315.5), but image upload was only possible at a median of 58\u2009percent (interquartile range\u2009=\u200935.1%\u201384.4%) of those weeks. Each physician participated for a median duration of 17\u2009weeks (interquartile range\u2009=\u200912\u201317), but X-ray image review was only possible at a median of 52\u2009percent (interquartile range\u2009=\u200949.7%\u201357.4%) of those weeks. Heavy workload was most frequently provided as the reason for missing data. Several infrastructural and technological challenges impaired the effective implementation of the mHealth tool, irrespective of its diagnostic accuracy.<\/jats:p>","DOI":"10.1177\/1460458220938535","type":"journal-article","created":{"date-parts":[[2020,7,18]],"date-time":"2020-07-18T06:10:53Z","timestamp":1595052653000},"page":"2762-2775","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":20,"title":["Implementing a socio-technical system for computer-aided tuberculosis diagnosis in Peru: A field trial among health professionals in resource-constraint settings"],"prefix":"10.1177","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2833-9087","authenticated-orcid":false,"given":"Cesar","family":"Ugarte-Gil","sequence":"first","affiliation":[{"name":"Universidad Peruana Cayetano Heredia, Per\u00fa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Icochea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Llontop Otero","sequence":"additional","affiliation":[{"name":"Hospital de Huaycan, Ministerio de Salud, Per\u00fa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerine","family":"Villaizan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Young","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia, Per\u00fa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benyuan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terence","family":"Griffin","sequence":"additional","affiliation":[{"name":"University of Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria J","family":"Brunette","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia, Per\u00fa; University of Massachusetts, USA; The Ohio State University, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,7,18]]},"reference":[{"key":"bibr1-1460458220938535","volume-title":"Global tuberculosis report 2019","author":"World Health Organization","year":"2019"},{"key":"bibr2-1460458220938535","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002754"},{"key":"bibr3-1460458220938535","volume-title":"Norma t\u00e9cnica de salud para la atenci\u00f3n integral de las personas afectadas por tuberculosis","author":"Ministerio de Salud","year":"2013"},{"key":"bibr4-1460458220938535","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30024-8"},{"key":"bibr5-1460458220938535","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2010.02715.x"},{"key":"bibr6-1460458220938535","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-017-0551-y"},{"key":"bibr7-1460458220938535","doi-asserted-by":"publisher","DOI":"10.17843\/rpmesp.2017.343.2859"},{"key":"bibr8-1460458220938535","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30308-3"},{"key":"bibr9-1460458220938535","first-page":"s243","volume":"53","author":"Alcalde-Rabanal JE","year":"2011","journal-title":"Salud P\u00fablica M\u00e9xico"},{"key":"bibr10-1460458220938535","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.11.0004"},{"key":"bibr11-1460458220938535","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-013-2840-z"},{"key":"bibr12-1460458220938535","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-016-1460-z"},{"issue":"10","key":"bibr13-1460458220938535","first-page":"1123","volume":"10","author":"Zellweger J","year":"2006","journal-title":"Int J Tuberc Lung Dis"},{"key":"bibr14-1460458220938535","doi-asserted-by":"publisher","DOI":"10.1016\/j.smhl.2020.100117"},{"key":"bibr15-1460458220938535","volume-title":"WHO guideline: recommendations on digital interventions for health system strengthening","author":"World Health Organization","year":"2019"},{"key":"bibr16-1460458220938535","author":"Trist E","year":"1981","journal-title":"The evolution of socio-technical systems"},{"key":"bibr17-1460458220938535","volume-title":"Community based participatory research for health","author":"Minkler M","year":"2003"},{"key":"bibr18-1460458220938535","doi-asserted-by":"crossref","unstructured":"Odendaal WA, Anstey Watkins J, Leon N, et al. 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