PT - JOURNAL ARTICLE AU - Luke Ravenscroft AU - Stewart Kettle AU - Ruth Persian AU - Simon Ruda AU - Lilian Severin AU - Svetlana Doltu AU - Benjamin Schenck AU - George Loewenstein TI - Video observed therapy (VOT) and medication adherence for TB patients: RCT in Moldova AID - 10.1183/13993003.00493-2020 DP - 2020 Jan 01 TA - European Respiratory Journal PG - 2000493 4099 - http://erj.ersjournals.com/content/early/2020/04/20/13993003.00493-2020.short 4100 - http://erj.ersjournals.com/content/early/2020/04/20/13993003.00493-2020.full AB - Introduction The effectiveness of Video Observed Therapy (VOT) for treating Tuberculosis (TB) has not been measured in low and middle-income countries (LMICs), where more than 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 2-arm individually randomised trial with 197 TB patients (n=99 in DOT control group; 98 in VOT treatment group, MDR-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 two-week period during the course of their treatmentResults VOT significantly decreased non-adherence by 4 days (95% CI, 3.35 to 4.67 days; p<0.01) per two-week period: 5.24 days missed per two-week period for DOT and 1.29 days for VOT. VOT patients spent 504 Moldovan Leu (MDL) (approximately €25; 95% CI, 277 to 730 MDL; p<0.01) and 58 h (95% CI, 48 to 68 h; p<0.01) less on their treatment. VOT also increased self-reported satisfaction with treatment. We found no significant results pertaining to treatment success, patient well-being or patient employment status and some evidence of an increase in side effects.Discussion In this trial, Video Observed Therapy (VOT) increased observed medication adherence for tuberculosis patients in Moldova, a LMIC, when compared to clinic-based Directly Observed Therapy (DOT). VOT also significantly reduced the time and money patients spent on their treatment.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Mr. Ravenscroft reports other from United Nations Development Programme (UNDP), during the conduct of the study; .Dr. Ravenscroft reports other from United Nations Development Programme (UNDP), during the conduct of the study.Conflict of interest: Dr. Kettle reports other from United Nations Development Programme (UNDP), during the conduct of the study.Conflict of interest: Ms. Persian reports other from United Nations Development Programme (UNDP), during the conduct of the study.Conflict of interest: Mr. Ruda reports other from United Nations Development Programme (UNDP), during the conduct of the study; .Dr. Ravenscroft reports other from United Nations Development Programme (UNDP), during the conduct of the study.Conflict of interest: Dr. Severin reports personal fees from UNDP Moldova, grants from PAS Center, non-financial support from Moldcell Company, during the conduct of the study; personal fees from UNDP Moldova, outside the submitted work.Conflict of interest: Dr. Doltu reports personal fees from UNDP Moldova, grants from PAS Center, non-financial support from Moldcell Company, during the conduct of the study; personal fees from UNDP Moldova, outside the submitted work.Conflict of interest: Ben Schenck has nothing to disclose.Conflict of interest: Dr. Loewenstein has nothing to disclose.