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

Abstract

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.