Acceptability of video observed treatment vs. directly observed treatment for tuberculosis: a comparative analysis between South and Central India

Abstract

Background Directly Observed Treatment (DOT) is a requirement in the management of Tuberculosis (TB) globally. With the transition from alternate day treatment to daily treatment in India, monitoring treatment adherence through DOT is a logistic challenge. The pervasiveness of mobile phones in India provides a unique opportunity to address this challenge remotely. This study was designed to compare the acceptability of mobile phones for antitubercular treatment (ATT) support in two distinct regions of India. Methodology This was a cross-sectional exploratory study that enrolled 351 patients with TB, of whom 185 were from Bangalore, South India, and 166 from Ujjain, Central India. Trained research assistants administered a pretested questionnaire comprising demographics, phone usage patterns, and acceptability of mobile phone technology to support treatment adherence to TB medicines. Results The mean age of the 351 participants was 32±13.6 years of whom 140 (40%) were women. Of the participants, 259 (74%) were urban, 221 (63%) had >4 years of education. A significantly greater number of participants were newly diagnosed with TB and were in the intensive phase of treatment. Overall, 218 (62%) preferred vDOT over DOT. There was an overall difference in preference between the two sites which is explained by differences in socio-economic variables. Conclusion Mobile phone adherence support is acceptable to patients on Antitubercular treatment ATT with minor variations in design based on demographic and cultural differences. In India, the preference for voice calls over text messages/SMS while designing mHealth interventions cannot be ignored. Of importance is the preference for DOT over vDOT in central India, unlike South India. However, in time, the expanding use of mobile technology supplemented with counseling, could overcome the barriers of privacy and stigma and promote the transition from in-person DOT to vDOT or mobile phone adherence monitoring and support for ATT in India.

Feasibility and acceptability pilot of video-based direct observed treatment (vDOT) for supporting antitubercular treatment in South India: a cohort study

“…Being asynchronous, vDOT has similar benefits as 99DOTS and sensor observed treatment (SOT), namely, convenience, decreased absenteeism from work and reduction in travel costs 18. In addition, logistic difficulties during the manufacturing and supply of customised sleeves for the ATT blister packs used in 99DOT are avoided 21.…”

“…Being asynchronous, vDOT has similar benefits as 99DOTS and sensor observed treatment (SOT), namely, convenience, decreased absenteeism from work and reduction in travel costs. 18 In addition, logistic difficulties during the manufacturing and supply of customised sleeves for the ATT blister packs used in 99DOT are avoided. 21 vDOT can also minimise the discomfort or extra effort associated with SOT, which requires the patient to Open access wear wireless wearable readers that capture data from the sensor within the ingested pill.…”

“…This was a part of a larger trial that uses vDOT as an adherence monitoring and treatment support tool (CTRI no: CTRI/2017/07/009052). Prior to the development of the intervention, acceptability of such an intervention among PwTB was conducted in Bangalore, South India and in Ujjain, Central India 17 18. Patients’ suggestions and concerns were taken into consideration during the design of the trial and during the development of the v.Cure application.…”

Video Observed Therapy (VOT) for People with Tuberculosis (TB): A Scoping Review

“…Except for a single study in the Philippines 26 , in which uptake of VOT was low (36%), all found VOT acceptable to people with TB and healthcare providers. A preference amongst people with TB for VOT over DOT was reported to relate to increased convenience, time-saving, and flexibility [22][23][24][25][32][33][34]36,37,[40][41][42]48,54 . Amongst healthcare workers, two studies from China and The Philippines, reported a preference for VOT over DOT 26,37 .…”

Digital Adherence Technologies Linked to Mobile Money Incentives for Medication Adherence Among People Living With Tuberculosis: Mixed Methods Feasibility and Acceptability Study

“…Constraints to tuberculosis medication adherence include a lack of transport to the clinic to pick up the drugs and forgetfulness [ 1 ]. Digital adherence technologies (DATs) are being explored to encourage adherence to tuberculosis medication [ 2 , 3 ]. Recently, we showed that real-time adherence monitors linked to SMS text message reminders were potentially useful in reminding patients to take their medication and encouraging tuberculosis medication adherence in rural Uganda [ 4 ].…”