Short and long-term outcomes of video observed treatment in tuberculosis patients, the Republic of Moldova

Abstract

Introduction: The Republic of Moldova is among the 18 high priority countries for tuberculosis (TB) in Europe. This study compared adherence and short and long-term TB treatment outcomes for TB patients who experienced asynchronous Video Observed Treatment (aVOT) during three months of outpatient treatment versus Directly Observed Treatment (DOT) in operational conditions in 2016-2017 in Chisinau.
 Methodology: We used secondary data from the 2016-2017 Randomized Clinical Trial (RCT) that piloted the aVOT Strategy in Chisinau and data from the national TB register. Relative risk was selected as a measure of association in analysis of treatment strategies (aVOT and DOT under operational conditions) and short and long-term treatment outcomes.
 Results: From 647 TB patients included in the study, 169 followed the treatment strategy in the RCT (83 in aVOT and 86 in DOT) and 478 were on DOT in operational conditions. Those in aVOT were more likely to have favourable short-term outcome than patients with DOT in operational conditions (RR 0.07; p < 0.001). TB recurrence as an indicator for the long-term outcome, was observed in group with DOT in operational conditions (40 cases, p = 0.006).
 Conclusions: This study demonstrated that the aVOT treatment strategy was associated with better adherence and both short and long-term TB treatment favourable outcomes. aVOT as a new patient-centred approach supporting TB patients on improving treatment adherence and outcomes might be recommended as an alternative to DOT strategy in the Republic of Moldova.

Mapping the effectiveness of the community tuberculosis care programme: A systematic review

“…They consisted of eleven RCTs(14,15,24,16–23), four cluster randomised control trials(25–28), nineteen seventeen cohort studies(29,30,39–47,31–38), one records reviews(48) and one quasi trial(49). All thirty-six had a control group and provided estimates of effect: Eleven evaluated community health care worker direct observation therapy (CHWDOT)(24,27,31,38)(14,19,25,26,29,33,39), nine evaluated family direct observation therapy (FDOT) (21–23,28,37,40,41,48–50), five evaluated short Message Service reminders (SMS) (15–18,51,52), six examined video observed therapy(VOT) (20,32,34,35,43,44) and five examined the electronic medication monitors (EMM) (30,42,45–47) See Fig 2 . Substantive descriptions of the included studies including intervention evaluated can be seen in Table 2 and 3…”

“…The thirty-six included studies were published between 2000 and 2021. They consisted of eleven RCTs (14,15,24,(16)(17)(18)(19)(20)(21)(22)(23), four cluster randomised control trials (25)(26)(27)(28), nineteen seventeen cohort studies (29,30,(39)(40)(41)(42)(43)(44)(45)(46)(47)(31)(32)(33)(34)(35)(36)(37)(38), one records reviews (48) and one quasi trial (49). All thirty-six had a control group and provided estimates of effect: Eleven evaluated community health care worker direct observation therapy (CHWDOT) (24,27,31,38) (14,19,25,26,29,33,39), nine evaluated family direct observat...…”

“…The asynchronous design allows participants to take their medications regardless of network connectivity (e.g., while traveling) because videos uploaded automatically whenever cellular or WiFi connections is established. An application status screen allows participants to see when videos were uploaded or pending (64) (34) (20). This intervention can also be accessed using a live video (Synchronous video-observed therapy), here the VOT worker and patient pre-arrange a schedule for the VOT calls.…”

“…Two cohort studies conducted in developed countries of Australia and United State of America in 2012 and 2017 reported a risk ratio ranging between 0.99-1.47(95% CI 0.93-2,25) for treatment completion with VOT compared with in-person DOT (32) (44). Another cohort study in the lowand middle-income country of Moldova in 2021 reported a treatment success risk ratio of 0.07 (95% CI 0.0-0.5) to VOT compared with Facility DOT (34). One RCT in a high income country of the United Kingdom conducted in 2019 reported a higher proportion of treatment completion rates with VOT compared with in-person DOT, (OR 2.52, 95% CI 1.17-5.47), but the effect on treatment completion rates was not statistically significant.…”

Tuberculosis Treatment Compliance Under Smartphone-Based Video-Observed Therapy Versus Community-Based Directly Observed Therapy: Protocol for a Cluster Randomized Controlled Trial

“…Previous studies reported that in western countries, A-VOT has better patient compliance, cost utility, and acceptability than DOT [ 10 - 13 ]. However, these studies assessed A-VOT according to the number of observations of clinic-based and comprehensive community-based DOT.…”