Video Observed Treatment (VOT)
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Digital Adherence Technologies
Video Observed Treatment (VOT)
Video Observed Treatment (VOT) allows patients to video record their medication intake, which the health care provider can watch at a later stage.
Patients are guided through a secured mobile application to record videos of themselves ingesting their daily medication. This is then uploaded to a secure remote server that can be accessed by the health care provider to review the doses taken.
If a video is not sent when expected, or if the medication intake is unclear in the video, the healthcare worker can contact the patient to determine the problem and provide support, to ensure future medication adherence.
Considerations
To determine whether video observed treatment (VOT) is suitable for target population and context, certain elements need to be considered.
Each consideration is scored according to a favourability scale as low, medium or high. Low indicating less favourability, and high indicating increased favourability compared to the other digital adherence technologies.
These considerations are based on the ASCENT Project Technical Brief, summarizing the implementation experiences with three technologies in 5 countries.
EASE FOR PATIENT TO USE TECHNOLOGY: LOW
- Patient needs to record medication intake by video for the entire treatment duration. This is expected to take 3 – 5 minutes each day.
- Patient may feel uncomfortable about privacy associated with video recording themselves.
EASE FOR HEALTHCARE WORKER TO USE TECHNOLOGY: LOW
- Provider needs to review and verify each patient medication intake video. This is expected to take 4 – 6 minutes per patient per day. However, this can take longer if there is a video recording error that needs to be followed up on.
ACCESSIBILITY: LOW
- Patient needs daily access to a smart phone.
- Patient needs daily access to Wi-Fi or mobile data network.
- Health care provider requires technology to review videos – a smartphone / tablet or computer as well as data or Wi-Fi.
- Country legislation on data and privacy may restrict sending, storing, and sharing videos.
EASE OF IMPLEMENTATION: HIGH
- No specialized in-country infrastructure required.
- Video recording adherence app can be easily downloaded and installed.
SUITABILITY FOR USE WITH DIFFERENT DRUG TYPES: HIGH
- Suitable across all medication types.
Implementation Requirements
Smartphone access
Patient has daily access to a smartphone.
Mobile data or Wi-Fi
Patient has daily access to mobile data / Wi-Fi, throughout treatment.
Server
Secure video storage server has been set-up in country.
Adherence platform access for provider
Healthcare provider can use smartphone, tablet, or laptop to access online adherence platform.
Time to review videos
Healthcare provider has sufficient time each day to review patient videos.
Follow-up based on adherence
Targeted follow-up actions and support by healthcare providers and other staff based on adherence.
Country Implementers
Belarus
Patient Target
DS-TB
MDR-TB
Scale
694
Publications
Video-observed treatment for tuberculosis patients in Belarus: findings from the first programmatic experience | European Respiratory Society (ersjournals.com)
Haiti
Patient Target
DS-TB Patients, prisoners / recent parolees
Scale
150
Publications
Kenya
Patient Target
DS-TB
Scale
500
DAT Combination
VOT, Medication Sleeve
Mozambique
Patient Target
MDR-TB
Scale
250
Philippines
Patient Target
DS-TB
DR-TB
Scale
20200
Publications
Ukraine
Patient Target
DS-TB
DR-TB
Scale
15900
DAT Combination
VOT, Smart Pill Box
Publications
China
Patient Target
DS-TB
Scale
810
Publications
India
Patient Target
DS-TB
Scale
25
Publications
Kyrgyzstan
Patient Target
DS-TB
MDR-TB
Scale
100
Nigeria
Patient Target
MDR-TB
Scale
7500
DAT Combination
VOT, Medication Sleeves
Publication
South Africa
Patient Target
DS-TB
DR-TB
XDR-TB (150 patients)
Scale
15150
DAT Combination
VOT, Medication Sleeves, Smart Pill Box
Vietnam
Patient Target
DS-TB
Scale
40
DAT Combination
VOT, Medication Sleeves, Smart Pill Box
Publications
Eswatini
Patient Target
MDR-TB patients
Scale
150
India
Patient Target
DS-TB
Scale
12100
DAT Combination
VOT, Medication Sleeves, Smart Pill Box
Publication
PAPINENI-MASTEROFMEDICALSCIENCESTHESIS-2020.pdf (harvard.edu)
Moldova
Patient Target
DS-TB (516 patients)
DR-TB (134 patients)
Scale
650
Publication
Video observed therapy (VOT) and medication adherence for TB patients: RCT in Moldova | European Respiratory Society (ersjournals.com)
Paraguay
Patient Target
DS-TB
Scale
50
Uganda
Begin Implementation
Publications
Technical Brief: 5 Country Experiences with Digital Adherence Technologies
Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial
The impact of digital health technologies on tuberculosis treatment: a systematic review
Video Directly Observed Therapy to support adherence with treatment for tuberculosis in Vietnam: A prospective cohort study
Video directly observed therapy for supporting and monitoring adherence to tuberculosis treatment in Uganda: a pilot cohort study