I kind of wish most TOTP implementations (apps and/or desktop software) would support exporting all of the current data in an encrypted file format, a bit like KeePass has .kdbx databases with your passwords and other information.
To me, that feels like the missing piece in my mostly-offline way of managing credentials and backing them up - I could throw the KeePass database and this TOTP database (presumably both protected by passwords) in a VeraCrypt container (also encrypted) or something similar, put that on an SD card and then store it somewhere in case of hardware failures or other factors like that.
Personally I think that TOTP is great and while there are plugins for KeePass for example, most people will opt for using various apps which don't always let you fully be in control of your files. As for cloud options - they are easy to use, of course, but personally that feels like a major risk, which the LastPass breach somewhat confirmed.
Overall, Aegis is my to-go open-source alternative to Authy.