Short and long-term outcomes of video observed treatment in tuberculosis patients, the Republic of Moldova.

Svetlana Doltu,Yuliia Sereda,Ana Ciobanu,Anthony Reid,Luke Ravenscroft,Liana Kasyan,Nune Truzyan,Andrei Dadu,Ruth Persian

doi:10.3855/jidc.14601

Abstract

The Republic of Moldova is among the 18 high priority countries for tuberculosis (TB) in Europe. This study compared adherence and short and long-term TB treatment outcomes for TB patients who experienced asynchronous Video Observed Treatment (aVOT) during three months of outpatient treatment versus Directly Observed Treatment (DOT) in operational conditions in 2016-2017 in Chisinau. We used secondary data from the 2016-2017 Randomized Clinical Trial (RCT) that piloted the aVOT Strategy in Chisinau and data from the national TB register. Relative risk was selected as a measure of association in analysis of treatment strategies (aVOT and DOT under operational conditions) and short and long-term treatment outcomes. From 647 TB patients included in the study, 169 followed the treatment strategy in the RCT (83 in aVOT and 86 in DOT) and 478 were on DOT in operational conditions. Those in aVOT were more likely to have favourable short-term outcome than patients with DOT in operational conditions (RR 0.07; p < 0.001). TB recurrence as an indicator for the long-term outcome, was observed in group with DOT in operational conditions (40 cases, p = 0.006). This study demonstrated that the aVOT treatment strategy was associated with better adherence and both short and long-term TB treatment favourable outcomes. aVOT as a new patient-centred approach supporting TB patients on improving treatment adherence and outcomes might be recommended as an alternative to DOT strategy in the Republic of Moldova.

Highlights

The Republic of Moldova is among the 18 high priority countries for tuberculosis (TB) in Europe
There were no differences in the presence of health insurance before TB diagnosis (50/83, 60% in asynchronous Video Observed Treatment (aVOT) and 51/86, 59% in Directly Observed Treatment (DOT); p = 0.901) and satisfactory living conditions (67/80, 83% in aVOT and 60/79, 76% in DOT; p = 0.22; missing data were excluded = 10) in the Randomized Clinical Trial (RCT) groups
A systematic review of RCTs confirms that video-observed therapy (VOT) has the RCT- randomized clinical trial; DOT-Directly Observed Treatment; aVOT-Asynchronous Video Observed Treatment; p-value < 0.001 (Fisher test); RR = 0.07; CI [0.0-0.5]

Summary

Introduction

The Republic of Moldova is among the 18 high priority countries for tuberculosis (TB) in Europe. Considerable investments were made in the Republic of Moldova to improve TB surveillance, diagnosis, adherence, and treatment as well as to reform TB control and health care systems in line with WHO recommendations over recent years [3]. These efforts improved the key impact indicators such as TB mortality and TB notification rate which decreased respectively by 66% (from 18 to 6 per 100,000) and 38% (from 113 to 72 per 100,000) from 2010 to 2019 [3]. Prevention and response to the spread of TB are public health priorities in the Republic of Moldova and are reflected in the National Tuberculosis Program (NTP) for 2016–2020; included is implementation of

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