Abstract
<title>Abstract</title> <p>Background Video Directly Observed Therapy (VDOT) offers the potential to improve Tuberculosis (TB) treatment adherence through remote monitoring. However, evidence on stakeholder perceptions of VDOT implementation in low-resource settings remains limited. This study explored policymakers’ and healthcare workers’ perceptions of VDOT in Uganda. Methods This qualitative study used key informant interviews (KIIs) among purposively sampled policymakers and healthcare workers in Kampala, Uganda. Twenty key informants (nine policymakers, eleven healthcare workers) participated. Semi-structured interview guides explored VDOT perceptions, benefits, barriers, and implementation feasibility. Interviews were conducted in English, audio-recorded, transcribed verbatim, deductively coded, and analysed using the Consolidated Framework for Implementation Research (CFIR). Results Participants perceived VDOT as credible and advantageous for improving adherence through real-time monitoring and enhanced accountability. Implementation barriers operated at multiple levels: patient-level barriers included limited smartphone access, unreliable electricity and internet, low digital literacy, stigma, and privacy concerns; health system barriers included infrastructure gaps, resource limitations, workflow constraints, and variable facility readiness. While VDOT was perceived as potentially cost-saving over traditional DOT, upfront costs and sustainability raised concerns. The policy environment was broadly supportive, though VDOT was not an immediate priority. Participants recommended a phased, hybrid approach with strong leadership and multi-stakeholder collaboration. Conclusion VDOT presents a promising innovation to strengthen TB treatment adherence. However, its translation from pilot success to routine practice requires careful alignment with patient realities, health system capacity, and policy priorities.</p>