Belarus experience in video observed treatment for tuberculosis patients

<b>Background:</b> Directly observed treatment (DOT) presents challenges for patients and health care staff. Video observed treatment (VOT) can help bridge the gap between patients and health services and facilitate adherence. In February 2015 the Ministry of Health of Belarus, with WHO’s support piloted VOT for TB patients in Minsk. The intervention was aligned to the digital health target product profiles developed by WHO/ERS (2015). Following a pilot project VOT was expanded countrywide with the Global Fund support in October 2016. <b>Methods:</b> A smartphone application was developed. Patients were provided with smartphones and internet access, and trained how to record and transmit video files to clinical staff. <b>Results:</b> By February 1, 2019, 694 TB patients across the country were recruited: median age 35 years (range:18-68); 62% male; 53% employed, 5% students, 37% unemployed, 4% on maternity leave, 1% on military service; 45% had drug susceptible TB, 4% rifampicin monoresistant TB, and 51% M/XDR-TB (including pre-XDR-TB – 17%; XDR-TB – 14%. 98% VOT registered episodes were classified of excellent quality; no smartphone was lost. The following final treatment outcomes were recorded in 317 patients (377 patients are still on treatment): treatment success – 303 (96%), treatment failure – 4 (1%), death – 2 (0.5%), lost to follow up – 8 (2.5%). <b>Conclusions:</b> Our data on VOT demonstrate high levels of treatment adherence and excellent treatment outcomes among a diverse types of TB patients in Belarus. In light of national system transition from in-hospital to out-patient based TB care the experience gained can promote further expansion of VOT.