An assessment of video-observed treatment as an adherence support tool for patients with drug-resistant TB.

BACKGROUND: In 2017, WHO endorsed digital adherence technologies, including video-observed treatment (VOT), to support TB treatment adherence. In 2021, Eswatini implemented VOT to support adherence for drug-resistant TB (DR-TB) patients nationwide, although limited evidence exists regarding its feasibility and acceptability in low-resource settings.

METHODS: We conducted 33 in-depth interviews with DR-TB patients and health care providers (HCPs), across all four regions of Eswatini to explore their experiences with VOT.

RESULTS: The findings indicated broad acceptance of VOT among both HCPs and patients. HCPs reported that VOT strengthened their connection with patients, facilitated adherence, and increased their confidence in treatment outcomes. While most patients found VOT user-friendly and appreciated the independence and privacy it offered, elderly patients faced challenges using smartphones, which sometimes resulted in poor-quality video submissions.

CONCLUSION: VOT is feasible and acceptable among HCPs and patients in Eswatini. Further research is needed to evaluate the impact of VOT on treatment outcomes in high-burden and low-resource settings to inform the scale-up of similar digital health interventions in comparable contexts. Strengthening digital infrastructure and providing tailored support for elderly patients could further enhance VOT effectiveness and equity.