Video-observed treatment for tuberculosis patients in Belarus: findings from the first programmatic experience

Abstract

The treatment of tuberculosis requires daily intake of multiple medications for between 6 months and 2 years, or more [1, 2]. This long duration predisposes to the interruption of medications with the risk of the emergence of drug resistance, death, disease persistence and continued transmission of tuberculosis in the community. Directly observed treatment, together with patient support, has been recommended to improve adherence [3]. However, daily treatment observation presents challenges for both patients and observers, which have limited its implementation [4]. Digital technologies, like video (or virtually)-observed treatment (VOT) can help bridge the gap between patients and health services and promote adherence [5]. VOT usually requires patients to film themselves taking medications on a computer or mobile device and then transmit these images to a remote observer via the internet [6–9]. Video technology has been available for more than a decade, but the increasing availability of smartphones and broadband internet is making VOT practical to implement even in resource-constrained settings.

Video directly observed therapy for supporting and monitoring adherence to tuberculosis treatment in Uganda: a pilot cohort study

“…Previous studies in high-income [26,27,[30][31][32] and low-income countries [9,33] have reported high adherence and patient satisfaction with VDOT. One study from Kenya showed the promise of digital health interventions for supporting TB treatment success [34]; however, no published studies exist on the use of VDOT in Africa.…”

Active case finding and treatment adherence in risk groups in the tuberculosis pre-elimination era

“…This technology may allow enhanced case management and DOT to offer a more patient-centred approach, bridging the gap between TB patients and their healthcare providers, and reducing the need for resource-intensive face-to-face encounters. Early studies have demonstrated that VOT is both feasible and acceptable to patients receiving TB treatment in the USA and Mexico 78 , and in Belarus 79 . A randomised-controlled trial comparing adherence to TB therapy when treatment is delivered by VOT vs. standard DOT among hard-to-reach patients in London has recently been completed with extremely promising initial results, though full published results are awaited 80 .…”

Digital adherence technologies for the treatment of tuberculosis: landscape and research priorities

“…61 Surveys conducted in Argentina and China suggested feasibility of SMS-based strategies due to high cellphone ownership and literacy. 52,54 Implementation studies from high-and middle-income countries (USA, Canada, Belarus, Mexico) have suggested that VDOT has high feasibility, 56,[62][63][64] though some patients had to be shifted back to in-person DOT 56 and low video or audio quality sometimes made dose observation difficult. 63,65 Ingestible sensors had high feasibility in studies conducted in the USA and Mexico, with >95% of sensor signals detected after ingestion.…”