Feasibility and acceptability of asynchronous VOT among patients with MDR-TB

Casalme, D. J. O.; Marcelo, Danaida; Cuesta, D. M. dela; Tonquin, M.; Frias, M V G; Gler, Maria Tarcela

doi:10.5588/ijtld.21.0632

Cited by 5 publications

(20 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another common measure of effectiveness was treatment completion as defined by the WHO 76 , which was reported as higher with VOT than DOT in various studies 8,27,44 . Comparable treatment completion rates with VOT versus DOT were reported in other studies 4,26,28,36,47,68,71,76 . No study reported treatment completion rates to be worse amongst people using VOT compared to DOT but, notably, none were specifically designed to demonstrate treatment completion inferiority or superiority.…”

Section: Resultssupporting

confidence: 63%

“…Treatment success was higher amongst people with TB using VOT than DOT in one study 26 , but comparable between VOT and DOT in other studies 36,52,55,64 . Culture conversion rates for VOT were similar to DOT in three studies 37,52,71 .…”

Section: Resultsmentioning

confidence: 61%

“…Four studies (4/66, 8%) 9,36,55,57 were Randomised Control Trials (RCT) and, of the five systematic reviews, two 4,71 had an accompanying meta-analysis. One study 26 specifically evaluated VOT for supporting people with MDR-TB. No studies were identified that assessed VOT interventions amongst pregnant women or specifically amongst people with TB/HIV co-infection.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

Du Thinh,

Morgan,

Pereira

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: Tuberculosis (TB) remains a significant cause of morbidity and mortality globally, disproportionately affecting low- and middle-income countries (LMIC). Accessing Directly Observed Therapy (DOT) is associated with out-of-pocket costs and stigma. Video-observed therapy (VOT) is an alternative to DOT but evidence from LMIC with high TB burden is limited. To make recommendations for future VOT-related research and inform the design of a pilot implementation of VOT for people with multi-drug resistant TB (MDR-TB) in Mozambique, we did a scoping review of the evidence on VOT for people with TB. Methodology: We systematically searched five scientific databases and key grey literature repositories to identify eligible abstracts. Abstracts were reviewed and full-text records were identified and evaluated. Data from full-text records were extracted into four implementation theme categories: Feasibility, Acceptability, Cost, and Effectiveness (FACE). Content analysis was used to describe implementation successes and challenges, comparing VOT versus DOT where possible. The Crowe Critical Appraisal Tool (CCAT) was used to evaluate the quality of studies. Results: In total, 66 records were identified: 47 primary research studies, 13 reviews, and six grey literature documents. All studies were graded as moderate to high quality and reported against at least one FACE category. Studies from urban settings (n=34) and HIC (n=33) predominated. Where measured and described, VOT implementation was reported to be feasible (43/43, 100%) and acceptable (43/44, 97%). Of the 18/20 (90%) studies describing cost data, VOT was reported to offer savings to the health system compared to DOT. Patient costs were under-reported. Of the 21/23 (91%) studies describing effectiveness to improve adherence to TB treatment, VOT was reported to be non-inferior to DOT. Conclusion: In HIC settings, VOT was reported as feasible, acceptable, and similarly effective alternative to DOT. Further evidence on VOT is needed from LMIC with high TB burden.

show abstract

Section: Resultssupporting

confidence: 63%

Section: Resultsmentioning

confidence: 61%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Du Thinh,

Morgan,

Pereira

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…However, there are also local factors which further shape overall costs such as the cost of internet and SMS, the DAT and platform used, specific infrastructure used and patient population served, labor costs and treatment duration. There remain important barriers beyond widespread internet connectivity and infrastructure: these include limited availability, accessibility, and affordability of some technologies for persons in resource-limited areas, and similarly the availability and affordability of technical personnel needed to support the TB clinics (22, 33). Hence real-world cost, effectiveness, and implementation data from high TB-incidence, lower-income settings will remain paramount.…”

Section: Discussionmentioning

confidence: 99%

“…We did not evaluate the effectiveness of the DATs. This has been addressed in other related publications and an analysis of the feasibility and acceptability of DATs in the TB REACH projects is forthcoming (22). The technologies themselves have recognized limitations: for example, messages received or not received by the 99DOTS platform do not necessarily equate with medication ingestion, or lack thereof (23,24).…”

Section: Discussionmentioning

confidence: 99%

Costs of digital adherence technologies for tuberculosis treatment support

Nsengiyumva

Khan²,

Gler³

et al. 2023

Preprint

View full text Add to dashboard Cite

Digital adherence technologies (DATs) are increasingly used for tuberculosis (TB) adherence support, but information about their costs remains limited. We used microcosting to estimate health system costs (in 2022 US dollars) of 99DOTS pill sleeves and video-observed treatment (VOT), implemented in demonstration projects during 2018-21. Local cost estimates for standard directly observed treatment (DOT) were also obtained. The estimated per-person costs of 99DOTS for drug-sensitive (DS-) TB were $98, $106, and $174 in Bangladesh (n=719), the Philippines (n=396), and Tanzania (n=976) respectively. The estimated per-person costs of VOT were $1 154, $304, $457, and $661 in Haiti (n=87 DS-TB), Moldova (n=173 DS-TB), Moldova (n=135 drug-resistant [DR]-TB) and the Philippines (n=110 DR-TB) respectively. Health system costs of 99DOTS may be similar to or cheaper than standard DOT. VOT is considerably more expensive; labor cost offsets and/or economies of scale may yield savings relative to standard DOT in some settings.

show abstract

Implementation outcomes of tuberculosis digital adherence technologies: a scoping review using the RE-AIM framework

Chilala,

Foster,

Bahukudumbi

et al. 2024

Preprint

View full text Add to dashboard Cite

IntroductionGlobally, tuberculosis (TB) remains one of the leading infectious causes of death, with 1.3 million deaths. Digital adherence technologies (DATs) have the potential to provide person-centred care and improve outcomes. Using the RE-AIM framework, we conducted a scoping review of DAT implementations for TB treatment.MethodsWe searched eight databases for papers published between January 2000 and April 2023, using keywords for ‘tuberculosis’ and ‘digital adherence technology’. Articles meeting prespecified inclusion criteria and containing data on RE-AIM domains were included (PROSPERO-CRD42022326968). We defined ‘reach’ as comprising cellphone ownership and engagement by people with TB (PWTB) with DATs, ‘adoption’ as engagement by healthcare providers with DAT programs, ‘implementation’ as the fidelity of the DAT program implemented, and ‘maintenance’ as longer-term uptake of DATs.ResultsOf 10,313 records, 105 contributed to the synthesis. DATs included SMS, phone, 99DOTS, video-supported therapy and pillboxes. For ‘reach’, across various settings, cellphone access varied from 50-100% and 2-31% of PWTB were excluded from accessing DATs due to technology challenges. 36-100% of PWTB agreed to use a DAT. The weighted mean of DAT engagement over dose-days was 81% for SMS, 85% for phone, 61% for 99DOTS, 87% for pillbox and 82% for VST. Concerning ‘implementation’, the fidelity of DAT implementations was affected by technological issues such as cellphone coverage, DAT malfunction and provider-facing issues; including failure to initiate intensified patient management following low DAT engagement. Findings related to RE-AIM dimensions of ‘adoption’ and ‘maintenance’ were limited.ConclusionOur findings suggest that the ‘reach’ of DATs may be limited by a cascade of barriers, including limitations in cellphone accessibility and suboptimal sustained DAT engagement by PWTB. Video and pillbox DATs have higher levels of engagement. Implementation challenges included technological and provider-facing issues. Improving implementation outcomes may be important for TB DATs to achieve broader public health impact.

show abstract

Feasibility and acceptability of asynchronous VOT among patients with MDR-TB

Cited by 5 publications

References 0 publications

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

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

Costs of digital adherence technologies for tuberculosis treatment support

Implementation outcomes of tuberculosis digital adherence technologies: a scoping review using the RE-AIM framework

Contact Info

Product

Resources

About