Video-Observed Therapy as an alternative to Directly-Observed Therapy for active tuberculosis: a prospective study of feasibility and acceptability by patients and nurses in a low-incidence high-income area

STUDY AIM: Tuberculosis remains a public health issue in Switzerland. Adherence to treatment is a challenge. To promote adherence, Video-Observed Therapy (VOT) has been proposed as an alternative to Directly Observed Therapy (DOT) that is less stigmatising, respects patients’ privacy and uses less resources. This study aimed to assess (1) the feasibility and (2) the acceptability of VOT for tuberculosis by patients and specialised nurses in our area. METHODS: All subjects aged above 16 years with a newly diagnosed active tuberculosis, irrespective of site of infection, and followed by our centre could be included. Patients were provided with a pictogram-based smartphone app and trained by specialised nurses to send daily videos of their treatment to a secure platform. Acceptability by patients and by specialised nurses, ratio of number of videos sent to those expected and technical issues were prospectively recorded. RESULTS: Over 18 months, 55 patients were invited to participate. Four (7.2%) declined (92.7% acceptance rate). Of the remaining 51, 5 (9.8%) failed to start VOT, thus leaving 46 patients followed by VOT (their median age was 40.3 years with interquartile range [IQR] 33–45; 27 [53%] were female). Three cases (6.5%) dropped out. No cases of multidrug-resistant tuberculosis were documented. The ratio of total number of videos received/ expected (5744/6392) was 89.9%; the median individual ratio of videos sent/received was 96% (IQR: 73–100); the number of videos sent remained stable over 6 months. Of the 5744 videos sent, 312 (5.4%) showed minor technical problems. Results of an 18-item questionnaire showed that VOT was well accepted by our specialised nurses. CONCLUSIONS: VOT showed a high rate of acceptance by patients and specialised nurses in our area and appears to be a feasible alternative to DOT.