Video-observed therapy and medication adherence for tuberculosis patients: randomised controlled trial in Moldova

Abstract

IntroductionThe effectiveness of Video Observed Therapy (VOT) for treating Tuberculosis (TB) has not been measured in low and middle-income countries (LMICs), where more than 95% of TB cases and deaths occur. In this study, we analyse the effectiveness, and patient cost-difference, of VOT compared to clinic-based Directly Observed Therapy (DOT) in improving medication adherence in Moldova, a LMIC in Eastern Europe.MethodsThe study was a 2-arm individually randomised trial with 197 TB patients (n=99 in DOT control group; 98 in VOT treatment group, MDR-TB cases were excluded). The primary outcome was observed medication adherence, measured by the number of days that a patient failed to be observed adhering to medication for every two-week period during the course of their treatmentResultsVOT significantly decreased non-adherence by 4 days (95% CI, 3.35 to 4.67 days; p<0.01) per two-week period: 5.24 days missed per two-week period for DOT and 1.29 days for VOT. VOT patients spent 504 Moldovan Leu (MDL) (approximately €25; 95% CI, 277 to 730 MDL; p<0.01) and 58 h (95% CI, 48 to 68 h; p<0.01) less on their treatment. VOT also increased self-reported satisfaction with treatment. We found no significant results pertaining to treatment success, patient well-being or patient employment status and some evidence of an increase in side effects.DiscussionIn this trial, Video Observed Therapy (VOT) increased observed medication adherence for tuberculosis patients in Moldova, a LMIC, when compared to clinic-based Directly Observed Therapy (DOT). VOT also significantly reduced the time and money patients spent on their treatment.

Factors associated with unfavourable treatment outcomes among people with rifampicin-resistant tuberculosis in Armenia, 2014-2017

“…Our recommendation is also in line with international evidence [35]. Ravenscroft et al in their recent study also suggest new solutions for home-based care for TB patients [37]. In Moldova a video-observed treatment model was piloted and proven to be more effective and less costly for TB treatment [37].…”

“…Ravenscroft et al in their recent study also suggest new solutions for home-based care for TB patients [37]. In Moldova a video-observed treatment model was piloted and proven to be more effective and less costly for TB treatment [37]. This finding is also supported by the experience of Belarus and Australia -demonstrating effectiveness of video-observed treatment [38,39].…”

Tuberculosis in the time of COVID-19: quality of life and digital innovation

“…We aim to discuss these two areas by presenting two articles that appear in this issue of the European Respiratory Journal (ERJ) [11,12], and by making a rapid review of the evidence available on TB, QoL and TB rehabilitation in the literature by searching on Medline, as well as in the grey literature. The keywords "quality of life", "pulmonary rehabilitation" and "tuberculosis" were used without any time limits.…”

“…In this issue of the ERJ, RAVENSCROFT et al [12] evaluate the effectiveness of VOT for the first time in lowand middle-income countries. The authors evaluated the effectiveness and patient cost-difference of VOT by comparing VOT with clinic-based DOT in Moldova.…”

El VOT: una opción atractiva en la administración del tratamiento de la tuberculosis

“…uno de estos estudios, se realizó en Moldavia (Ravenscroft 2020) 25 , a 197 pacientes, que mostró una adherencia al tratamiento significativamente superior en el grupo vOt frente al grupo dOt. Sin embargo, puesto que el tiempo de observación fue de tan solo 14 días, la validez del mismo parece limitada.…”