Video supported treatment among vulnerable populations with tuberculosis: Data from prospective multi-centre single-arm cohort study in Catalonia, Spain.
Joan-Pau Millet, Mario Bravo-Masferrer, Xavi Casas, Andrii Dudnyk, Paquita Sánchez, Hernan Vargas-Leguas, Lydia Luque, Laura Gavaldà, M Carmen Ruíz, Miriam Montoro, Marina Lumbierres, Adrián Sánchez-Montalvá, Fina Sabrià, Virginia Pomar, Malú de Souza, Angeles Jiménez, Ignasi Parron, Pere Godoy, Cristina Rius
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Abstract
Introduction: Video supported treatment (VST) is intended as a complementary or alternative approach to directly observed treatment (DOT) in patients with tuberculosis (TB) contributing to treatment adherence and patient follow-up. This study aimed to evaluate efficacy of VST using emocha mobile app (Emocha Mobile Health Inc, Baltimore, MD, USA) in the cohort of vulnerable TB patients in Catalonia, Spain.
Methods: We conducted a prospective, multi-centre, single-arm, pilot implementation, study with a matched simultaneous comparison group using VST as a complementary tool to in-person DOT. Treatment adherence was measured as the proportion of validated videos over the total number expected. Odds ratios (OR) and adjusted odds ratios (aOR) assessed associations between patient characteristics and treatment success.
Results: Between December 2019 and January 2023, a total of 83 (14.4%) out of 577 initially screened TB patients were enrolled receiving VST. A total of 12,346 (80.8%) video records were validated from 15,280 being scheduled. 13 out of 83 (15.7%) patients were hospitalised and then switched to in-person DOT for later treatment completion. The rate of successful treatment outcomes among patients utilizing VST either exclusively or in combination with in-person DOT was 91.6% (76/83) while 8.4% (7/83) were loss to follow-up. The success rate increased by 5% (95%CI 2-8) per each percentage point increase in the proportion of time under VST out of the total treatment duration, according to the logistic regression analysis.
Conclusions: When combined with in-person DOT, VST may increase the proportion of observed doses and the likelihood of treatment success.
视频支持治疗（VST）旨在作为结核病（TB）患者直接观察治疗（DOT）的补充或替代方法，有助于治疗依从性和患者随访。本研究旨在评估使用emocha移动应用程序（emocha mobile Health Inc, Baltimore， MD， USA）的VST在西班牙加泰罗尼亚易感结核病患者队列中的疗效。方法：我们进行了一项前瞻性、多中心、单臂、试点实施的研究，使用VST作为面对面DOT的补充工具，并与匹配的同时对照组进行了研究。治疗依从性以验证视频数占预期总视频数的比例来衡量。优势比（OR）和调整优势比（aOR）评估患者特征与治疗成功之间的关系。结果：在2019年12月至2023年1月期间，577名最初筛查的结核病患者中共有83名（14.4%）接受了VST。在预定的15,280个视频记录中，共有12,346个（80.8%）被验证。83例患者中有13例（15.7%）住院，然后转为面对面的DOT治疗，以便后期完成治疗。单独使用VST或联合现场DOT治疗的患者治疗成功率为91.6%(76/83)，而8.4%（7/83）的患者随访失败。根据logistic回归分析，VST下的时间占总治疗时间的比例每增加一个百分点，成功率增加5% （95%CI 2-8）。结论：当与现场DOT联合使用时，VST可以增加观察剂量的比例和治疗成功的可能性。
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