Abstract
The World Health Organization recently recommended Video Observed Therapy (VOT) as one option for monitoring tuberculosis (TB) treatment adherence. There is evidence that private sector TB treatment has substandard treatment follow-up, which could be improved using VOT. However, acceptability of VOT in the private sector has not yet been evaluated. We conducted a cross-sectional survey employing a theoretical framework for healthcare intervention acceptability to measure private provider perceptions of VOT across seven constructs in three cities of Viet Nam: Ha Noi, Ho Chi Minh City, and Hai Phong. We investigated the differences in private providers' attitudes and perceptions of VOT using mixed ordinal models to test for significant differences in responses between groups of providers stratified by their willingness to use VOT. A total of 79 private providers completed the survey. Sixty-two providers (75%) indicated they would use VOT if given the opportunity. Between private providers who would and would not use VOT, there were statistically significant differences (p≤0.001) in the providers' beliefs that VOT would help identify side effects faster and in their confidence to monitor treatment and provide differentiated care with VOT. There were also significant differences in providers' beliefs that VOT would save them time and money, address problems faced by their patients, benefit their practice and patients, and be relevant for all their patients. Private providers who completed the survey have positive views towards using VOT and specific subpopulations acknowledge the value of integrating VOT into their practice. Future VOT implementation in the private sector should focus on emphasizing the benefits and relevance of VOT during recruitment and provide programmatic support for implementing differentiated care with the technology.
Highlights
In Viet Nam, an estimated 174,000 people developed tuberculosis (TB) in 2019 and there were 13,200 deaths from the disease, despite free treatment being readily available at government health facilities [1]
As public-private mix (PPM) Video Observed Therapy (VOT) projects have never been piloted, our study suggests that the widespread use of VOT can act as a facilitator for standardized treatment monitoring, convenient patient follow up, and improved treatment outcomes in the private sector [18]
Private providers surveyed across three different cities in Viet Nam expressed positive attitudes towards VOT technology and perceived value in using the VOT within their practice
Summary
In Viet Nam, an estimated 174,000 people developed tuberculosis (TB) in 2019 and there were 13,200 deaths from the disease, despite free treatment being readily available at government health facilities [1]. The NTP attributes these achievements to robust nationwide coverage of treatment services that included quality-assured diagnostics and standardized treatment regimen with supervision and patient support as well as facility-based directly observed treatment (DOT) as per national treatment guidelines [2]. While studies have found DOT can improve treatment outcomes [3], a more nuanced understanding of treatment observation has emerged in recent years. There are often conflicting views on whether DOT results in better treatment outcomes as compared to unsupervised, self-administered treatment. The World Health Organization recently recommended Video Observed Therapy (VOT) as one option for monitoring tuberculosis (TB) treatment adherence. There is evidence that private sector TB treatment has substandard treatment follow-up, which could be improved using VOT. Acceptability of VOT in the private sector has not yet been evaluated
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