INTRODUCTION: The effectiveness of video-observed therapy (VOT) for treating tuberculosis (TB) has not been measured in low- and middle-income countries (LMICs), where >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. METHODS: The study was a two-arm individually randomised trial with 197 TB patients (n=99 DOT control group; n=98 VOT treatment group; multidrug-resistant 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 2-week period during the course of their treatment. RESULTS:VOT significantly decreased nonadherence by 4 days (95% CI 3.35-4.67 days, p<0.01) per 2-week period: 5.24 days missed per 2-week period for DOT and 1.29 days for VOT. VOT patients spent MDL 504 (∼EUR 25) (95% CI MDL 277-730, p<0.01) and 58 h (95% CI 48-68 h, p<0.01) less on their treatment. In addition, VOT increased self-reported satisfaction with treatment. We found no significant results pertaining to treatment success, patient wellbeing or patient employment status and some evidence of an increase in side-effects. DISCUSSION: In this trial, VOT increased observed medication adherence for TB patients in Moldova, a LMIC, when compared to clinic-based DOT. Additionally, VOT significantly reduced the time and money patients spent on their treatment.
RCT Entities:
INTRODUCTION: The effectiveness of video-observed therapy (VOT) for treating tuberculosis (TB) has not been measured in low- and middle-income countries (LMICs), where >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. METHODS: The study was a two-arm individually randomised trial with 197 TB patients (n=99 DOT control group; n=98 VOT treatment group; multidrug-resistant 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 2-week period during the course of their treatment. RESULTS: VOT significantly decreased nonadherence by 4 days (95% CI 3.35-4.67 days, p<0.01) per 2-week period: 5.24 days missed per 2-week period for DOT and 1.29 days for VOT. VOT patients spent MDL 504 (∼EUR 25) (95% CI MDL 277-730, p<0.01) and 58 h (95% CI 48-68 h, p<0.01) less on their treatment. In addition, VOT increased self-reported satisfaction with treatment. We found no significant results pertaining to treatment success, patient wellbeing or patient employment status and some evidence of an increase in side-effects. DISCUSSION: In this trial, VOT increased observed medication adherence for TB patients in Moldova, a LMIC, when compared to clinic-based DOT. Additionally, VOT significantly reduced the time and money patients spent on their treatment.
Authors: O W Akkerman; R Duarte; S Tiberi; H S Schaaf; C Lange; J W C Alffenaar; J Denholm; A C C Carvalho; M S Bolhuis; S Borisov; J Bruchfeld; A M Cabibbe; J A Caminero; I Carvalho; J Chakaya; R Centis; M P Dalcomo; L D Ambrosio; M Dedicoat; K Dheda; K E Dooley; J Furin; J-M García-García; N A H van Hest; B C de Jong; X Kurhasani; A G Märtson; S Mpagama; M Munoz Torrico; E Nunes; C W M Ong; D J Palmero; R Ruslami; A M I Saktiawati; C Semuto; D R Silva; R Singla; I Solovic; S Srivastava; J E M de Steenwinkel; A Story; M G G Sturkenboom; M Tadolini; Z F Udwadia; A R Verhage; J P Zellweger; G B Migliori Journal: Int J Tuberc Lung Dis Date: 2022-07-01 Impact factor: 3.427
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Authors: D S Graciaa; R R Kempker; E Sanikidze; S Tukvadze; L Mikiashvili; R Aspindzelashvili; D Alkhazashvili; H M Blumberg; Z Avaliani; N Tukvadze Journal: Int J Tuberc Lung Dis Date: 2021-03-01 Impact factor: 2.373
Authors: A Perry; A Chitnis; A Chin; C Hoffmann; L Chang; M Robinson; G Maltas; E Munk; M Shah Journal: Int J Tuberc Lung Dis Date: 2021-08-01 Impact factor: 2.373
Authors: Joseph Burzynski; Joan M Mangan; Chee Kin Lam; Michelle Macaraig; Marco M Salerno; B Rey deCastro; Neela D Goswami; Carol Y Lin; Neil W Schluger; Andrew Vernon Journal: JAMA Netw Open Date: 2022-01-04