The introduction of video-enabled directly observed therapy (video-DOT) for patients with drug-resistant TB disease in Eswatini amid the COVID-19 pandemic - a retrospective cohort study.

Autor: Kerschberger B; Médecins Sans Frontières (MSF), Mbabane, Eswatini. bernhard.kerschberger@gmail.com., Daka M; Médecins Sans Frontières (MSF), Mbabane, Eswatini., Shongwe B; Médecins Sans Frontières (MSF), Mbabane, Eswatini., Dlamini T; National TB Control Programme (NTCP), Manzini, Eswatini., Ngwenya S; National TB Control Programme (NTCP), Manzini, Eswatini., Danbakli C; Médecins Sans Frontières, Geneva, Switzerland., Mamba B; National TB Control Programme (NTCP), Manzini, Eswatini., Nxumalo B; National TB Control Programme (NTCP), Manzini, Eswatini., Sibanda J; National TB Control Programme (NTCP), Manzini, Eswatini., Dube S; National TB Control Programme (NTCP), Manzini, Eswatini., Dlamini LM; National TB Control Programme (NTCP), Manzini, Eswatini., Mabhena E; Médecins Sans Frontières (MSF), Mbabane, Eswatini., Mukooza E; Médecins Sans Frontières (MSF), Mbabane, Eswatini., Crumley I; Médecins Sans Frontières, Geneva, Switzerland., Ciglenecki I; Médecins Sans Frontières, Geneva, Switzerland., Vambe D; National TB Control Programme (NTCP), Manzini, Eswatini.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2024 Jun 03; Vol. 24 (1), pp. 699. Date of Electronic Publication: 2024 Jun 03.
DOI: 10.1186/s12913-024-11151-4
Abstrakt: Background: Video-enabled directly observed therapy (video-DOT) has been proposed as an additional option for treatment provision besides in-person DOT for patients with drug-resistant TB (DRTB) disease. However, evidence and implementation experience mainly originate from well-resourced contexts. This study describes the operationalization of video-DOT in a low-resourced setting in Eswatini facing a high burden of HIV and TB amid the emergence of the COVID-19 pandemic.
Methods: This is a retrospectively established cohort of patients receiving DRTB treatment during the implementation of video-DOT in Shiselweni from May 2020 to March 2022. We described intervention uptake (vs. in-person DOT) and assessed unfavorable DRTB treatment outcome (death, loss to care) using Kaplan-Meier statistics and multivariable Cox-regression models. Video-related statistics were described with frequencies and medians. We calculated the fraction of expected doses observed (FEDO) under video-DOT and assessed associations with missed video uploads using multivariable Poisson regression analysis.
Results: Of 71 DRTB patients eligible for video-DOT, the median age was 39 (IQR 30-54) years, 31.0% (n = 22) were women, 67.1% (n = 47/70) were HIV-positive, and 42.3% (n = 30) were already receiving DRTB treatment when video-DOT became available. About half of the patients (n = 37; 52.1%) chose video-DOT, mostly during the time when COVID-19 appeared in Eswatini. Video-DOT initiations were lower in new DRTB patients (aHR 0.24, 95% CI 0.12-0.48) and those aged ≥ 60 years (aHR 0.27, 95% CI 0.08-0.89). Overall, 20,634 videos were uploaded with a median number of 553 (IQR 309-748) videos per patient and a median FEDO of 92% (IQR 84-97%). Patients aged ≥ 60 years were less likely to miss video uploads (aIRR 0.07, 95% CI 0.01-0.51). The cumulative Kaplan-Meier estimate of an unfavorable treatment outcome among all patients was 0.08 (95% CI 0.03-0.19), with no differences detected by DOT approach and other baseline factors in multivariable analysis.
Conclusions: Implementing video-DOT for monitoring of DRTB care provision amid the intersection of the HIV and COVID-19 pandemics seemed feasible. Digital health technologies provide additional options for patients to choose their preferred way to support treatment taking, thus possibly increasing patient-centered health care while sustaining favorable treatment outcomes.
(© 2024. The Author(s).)
Databáze: MEDLINE
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