Video observed therapy for multidrug-resistant tuberculosis: a qualitative study of patient perspectives

Abstract

BackgroundDirectly observed therapy (DOT) for monitoring treatment adherence for multidrug-resistant (MDR) tuberculosis is often impractical because of complicated dosing schedules. Video observed therapy (VOT) using internet and mobile technologies is potentially an efficient and cost-effective alternative for patients whose social circumstances enable them to maintain possession of a smartphone and regularly send video files. This study aimed to explore the attitudes and perspectives of patients with MDR tuberculosis supervised with VOT to inform future intervention development. MethodsSemi-structured interviews were conducted with ten patients with MDR tuberculosis receiving VOT in London, UK, between Oct 5, 2013, and March 10, 2014. With a grounded theory approach to organise comments into analytical themes, recorded interviews were conducted in patients’ homes or in cafés and transcribed verbatim. Practical and technical issues, effect on daily life, and emotional response, including feelings around surveillance, privacy, and security, were explored. FindingsThe interviews provided powerful insights into patients’ experiences and attitudes, both positive and negative, about the patient-observer relationship, the ways in which VOT helped structure tablet-taking, and practical issues around the use of technology. Overall, patients reported very high levels of satisfaction as illustrated by the following quotes: “I was getting tired of DOT. I thought I would be a lot freer to continue with my daily life—all that time and effort you've saved me—I didn't need much convincing. With the DOT, it felt like…there was some kind of stigma and for that reason they are monitoring you. It felt like being a criminal.” “I wouldn't have felt comfortable just meeting a person online—I would have been like, ‘who's that person, I don't even know him?’ But I'm really pleased you came all the way to my house, to make me comfortable and show me what to do…and I took it from there and it was really good.” InterpretationThis exploratory study suggests that VOT is practical and acceptable to patients with MDR tuberculosis, provided they receive effective training and continuing support. Qualitative investigation of patients’ experiences is essential to inform the future design, assessment, and implementation of this promising intervention. FundingThis study was supported by National Institute for Health Programme Grant for Applied Research (RP-PG-0407-10340).