Improving TB patient care in the Russian Federation with video-observed treatment

27 March 2019
To help tuberculosis (TB) patients keep to their gruelling treatment regimens, WHO recommends that the intake of medicines is observed, in person, by a health-care worker, to support the patient in taking the medication regularly. However, ensuring daily face-to-face contact at a health facility can be challenging for both patients and health service providers. Digital technologies, such as video-observed treatment (VOT) can help meet this challenge.

In 2016, the city of Tomsk in Siberia, Russian Federation, started supporting TB patients using VOT, which allowed patients to take TB drugs under the care of a nurse via video calling software on smart phones. Each patient signs an informed-consent form to begin VOT and agrees to be available for their daily session in a quiet room. Based on the agreed schedule, a health worker initiates the call. The health worker also advises the patient on the appropriate storage of medicines, which is an important aspect of treatment success.

The programme started with 6 patients and has grown to 88. Following the example of Tomsk, VOT is now available in other regions of the country, including Tyumen, Voronezh, Vladimir, Ivanovo and Arkhangelsk oblasts.

This treatment approach is considered a step forward in making care more people-centred and is valued by patients and nurses alike. VOT has been shown to improve access to TB treatment, support regular intake of drugs and treatment adherence, decrease the risks of occurrence of drug resistance and the spread of infection, and improve the overall quality of life for patients. It can decrease the financial burden for the health system, and for patients and their families, as patients no longer have to travel to a health centre every day for directly observed therapy. No breaks in treatment regimens have been reported since the launch of VOT.

Improving TB patient care... 1

Sarkisova Valentina, Prior to starting VOT, nurses are trained in the use of video calling and the specifics of supporting and caring for patients during the video sessions. Simple and clear instructions have been developed for both nurses and patients.  

 

Improving TB patient care... 2

Sarkisova Valentina, To join the programme, patients need to meet certain criteria: they need to own a device with video calling capability installed, they need to have proved during their hospital and outpatient care that they were able to keep to the treatment, and they need to be on a treatment regimen that only includes oral drugs.  

 

Improving TB patient care... 3

Sarkisova Valentina, All video sessions are recorded and stored confidentially in a database. This means that the quality of care provided by the nurse can be verified and monitored, giving health workers information on how well the guidance for VOT is followed.  

Improving TB patient care... 4

Sarkisova Valentina, Nurses play an important role in VOT: they can establish a trust-based, caring relationship with each individual patient, putting nurses in an ideal position to guide drug intake, warn about possible side-effects and drug interactions, give clear recommendations and, if required, refer the patient to a doctor.  

Improving TB patient care... 5

Sarkisova Valentina, Medical professionals understand that VOT cannot replace face-to-face consultations. That is why patients are asked to visit the clinic once every 7–10 days. This gives the patient a chance to speak with a doctor, ask further questions, complete any prescribed medical tests and receive TB drugs for the next 7–10 days.  

Improving TB patient care... 6

Sarkisova Valentina, Patients report that they are very satisfied with the VOT. They do not spend a lot of time on the video sessions, they can take their treatment at home and do not have to spend money and time travelling to the clinic every day. This is especially important for those patients who have to take drugs twice a day.  

 

Improving TB patient care... 7

Sarkisova Valentina, Patients find the technology easy and convenient. As one patient says, “I do not need to travel, use public transport or spend time and money. I can take the drugs at a time most convenient to me and either get connected via video or send the video message to a nurse”. Some patients even find it easier to communicate by phone when asking important questions related to their health or treatment, or when sharing concerns and worries.  

 

Improving TB patient care... 8

Sarkisova Valentina, VOT has become popular among patients and the prospect of being eligible for the programme once they go home is additional motivation for hospitalized patients to stick to their treatment.  

 

/