The introduction of video-enabled directly observed therapy (video-DOT) for patients with drug-resistant TB disease in Eswatini amid the COVID-19 pandemic - a retrospective cohort study

• Autores principales: Bernhard Kerschberger (Autor), Michelle Daka (Autor), Bhekiwe Shongwe (Autor), Themba Dlamini (Autor), Siphiwe Ngwenya (Autor), Clara Danbakli (Autor), Bheki Mamba (Autor), Bongekile Nxumalo (Autor), Joyce Sibanda (Autor), Sisi Dube (Autor), Lindiwe Mdluli Dlamini (Autor), Edwin Mabhena (Autor), Esther Mukooza (Autor), Iona Crumley (Autor), Iza Ciglenecki (Autor), Debrah Vambe (Autor)
• Formato: Libro
• Publicado: BMC, 2024-06-01T00:00:00Z.
• Materias: article
• Acceso en línea: Connect to this object online.
• Notes: 10.1186/s12913-024-11151-4; 1472-6963
• Keywords: Video-enabled DOT; DOT; Drug-resistant TB; COVID-19; Public aspects of medicine; RA1-1270
• Source: BMC Health Services Research, Vol 24, Iss 1, Pp 1-15 (2024)

Abstract Background Video-enabled directly observed therapy (video-DOT) has been proposed as an additional option for treatment provision besides in-person DOT for patients with drug-resistant TB (DRTB) disease. However, evidence and implementation experience mainly originate from well-resourced contexts. This study describes the operationalization of video-DOT in a low-resourced setting in Eswatini facing a high burden of HIV and TB amid the emergence of the COVID-19 pandemic. Methods This is a retrospectively established cohort of patients receiving DRTB treatment during the implementation of video-DOT in Shiselweni from May 2020 to March 2022. We described intervention uptake (vs. in-person DOT) and assessed unfavorable DRTB treatment outcome (death, loss to care) using Kaplan-Meier statistics and multivariable Cox-regression models. Video-related statistics were described with frequencies and medians. We calculated the fraction of expected doses observed (FEDO) under video-DOT and assessed associations with missed video uploads using multivariable Poisson regression analysis. Results Of 71 DRTB patients eligible for video-DOT, the median age was 39 (IQR 30-54) years, 31.0% (n = 22) were women, 67.1% (n = 47/70) were HIV-positive, and 42.3% (n = 30) were already receiving DRTB treatment when video-DOT became available. About half of the patients (n = 37; 52.1%) chose video-DOT, mostly during the time when COVID-19 appeared in Eswatini. Video-DOT initiations were lower in new DRTB patients (aHR 0.24, 95% CI 0.12-0.48) and those aged ≥ 60 years (aHR 0.27, 95% CI 0.08-0.89). Overall, 20,634 videos were uploaded with a median number of 553 (IQR 309-748) videos per patient and a median FEDO of 92% (IQR 84-97%). Patients aged ≥ 60 years were less likely to miss video uploads (aIRR 0.07, 95% CI 0.01-0.51). The cumulative Kaplan-Meier estimate of an unfavorable treatment outcome among all patients was 0.08 (95% CI 0.03-0.19), with no differences detected by DOT approach and other baseline factors in multivariable analysis. Conclusions Implementing video-DOT for monitoring of DRTB care provision amid the intersection of the HIV and COVID-19 pandemics seemed feasible. Digital health technologies provide additional options for patients to choose their preferred way to support treatment taking, thus possibly increasing patient-centered health care while sustaining favorable treatment outcomes.