Assessing private provider perceptions and the acceptability of video observed treatment technology for tuberculosis treatment adherence in three cities across Viet Nam

Abstract

Background The World Health Organization recently recommended Video Observed Therapy (VOT) as one option for monitoring tuberculosis (TB) treatment adherence. There is evidence that private sector TB treatment has substandard treatment follow-up, which could be improved using VOT. However, acceptability of VOT in the private sector has not yet been evaluated. Methods We conducted a cross-sectional survey employing a theoretical framework for healthcare intervention acceptability to measure private provider perceptions of VOT across seven constructs in three cities of Viet Nam: Ha Noi, Ho Chi Minh City, and Hai Phong. We investigated the differences in private providers’ attitudes and perceptions of VOT using mixed ordinal models to test for significant differences in responses between groups of providers stratified by their willingness to use VOT. Results A total of 79 private providers completed the survey. Sixty-two providers (75%) indicated they would use VOT if given the opportunity. Between private providers who would and would not use VOT, there were statistically significant differences (p≤0.001) in the providers’ beliefs that VOT would help identify side effects faster and in their confidence to monitor treatment and provide differentiated care with VOT. There were also significant differences in providers’ beliefs that VOT would save them time and money, address problems faced by their patients, benefit their practice and patients, and be relevant for all their patients. Conclusion Private providers who completed the survey have positive views towards using VOT and specific subpopulations acknowledge the value of integrating VOT into their practice. Future VOT implementation in the private sector should focus on emphasizing the benefits and relevance of VOT during recruitment and provide programmatic support for implementing differentiated care with the technology.

Stakeholders’ Perceptions of Benefits of and Barriers to Using Video-Observed Treatment for Monitoring Patients With Tuberculosis in Uganda: Exploratory Qualitative Study

“…Health care providers and patients perceived VDOT as a cost- and time-saving approach in the long run compared with costs that are likely to be incurred with frequent travel when using in-person DOT. Similar findings were reported in a study of health care providers in the private sector in urban Vietnam [ 39 ]. In addition, 4 studies quantified the time spent on the treatment observation process and found a significantly larger saving in time and money compared with the usual DOT [ 21 , 36 , 40 , 41 ].…”

“…The technology usability barrier is likely to affect mostly older patients and those without formal education. Similar findings have been reported in VDOT studies conducted in Vietnam, Cambodia, and South India [ 23 , 37 , 39 ]. In our experience with the VDOT pilot study, intensive training with clear instructions to patients helped them gain the required skills.…”

“…The perceived benefits of VDOT highlight aspects that can be enhanced to increase acceptability among users. The ease of monitoring, convenience, access to objective evidence of dosing, and facilitation of timely follow-up have also been reported in previous studies [ 23 , 25 , 37 , 39 ]. Health care providers and patients perceived VDOT as a cost- and time-saving approach in the long run compared with costs that are likely to be incurred with frequent travel when using in-person DOT.…”

“…Privacy and confidentiality issues with the use of VDOT were raised as perceived benefits and potential threats. Previous VDOT studies conducted in India, the United States, and Vietnam have also reported similar mixed concerns with privacy [ 24 , 25 , 39 ]. The importance of preserving confidentiality, guarding against unintended disease disclosure, and stigma also emerged as prominent themes in studies on acceptance of mobile health (mHealth) interventions among people living with HIV in rural and urban Uganda [ 26 , 30 , 45 ].…”

Evaluating novel engagement mechanisms, yields and acceptability of tuberculosis screening at retail pharmacies in Ho Chi Minh City, Viet Nam

“…We developed an English language acceptability survey consisting of 27 questions (S1 Survey) using a theoretical framework for healthcare intervention acceptability which encompasses seven key constructs: 1) ethicality; 2) intervention coherence; 3) burden; 4) opportunity cost; 5) perceived effectiveness; 6) self-efficacy; and 7) affective attitude (S1 Table) [26,27]. Additional questions captured pharmacist demographics and measured perceptions of the implementation plan and usability of the technology.…”