PDF(Pubmed)
Abstract：
BACKGROUND: Improving treatment success rates among multi drug-resistant tuberculosis (MDR-TB) patients is critical to reducing its incidence and mortality, but adherence poses an important challenge. Video-based direct observed therapy (vDOT) may provide adherence benefits, while addressing the time and cost burden associated with community treatment supporter (CTS)-DOT. This study explored experiences of patients, family members and healthcare workers with different DOT modalities for adherence support in Eswatini.
METHODS: Between April 2021 and May 2022, thirteen men and five women with MDR-TB, ten healthcare workers, and nine caregivers were purposively sampled to include a range of characteristics and experiences with DOT modalities. Data were generated through individual in-depth interviews and a smartphone messaging application (WhatsApp). Data coding was undertaken iteratively, and thematic analysis undertaken, supported by Nvivo.
RESULTS: Four themes emerged that reflected participants\' experiences with different DOT modalities, including stigma, efficiency, perceived risks of TB acquisition, and patient autonomy. vDOT was appreciated by patients for providing them with privacy and shielding them from stigmatisation associated with being seen in TB clinics or with community treatment supporters. vDOT was also seen as more efficient than CTS-DOT. Health workers acknowledged that it saved time, allowing them to attend to more patients, while many patients found vDOT more convenient and less expensive by removing the need to travel for in-person consultations. Health workers also appreciated vDOT because it reduced risks of TB acquisition by minimising exposure through virtual patient monitoring. Although many patients appreciated greater autonomy in managing their illness through vDOT, others preferred human contact or struggled with making video recordings. Most family members appreciated vDOT, although some resented feeling removed from the process of supporting loved ones.
CONCLUSIONS: vDOT was generally appreciated by MDR-TB patients, their family members and health workers as it addressed barriers to adherence which could contribute to improved treatment completion rates and reduced workplace exposure. However, patients should be offered an alternative to vDOT such as CTS-DOT if this modality does not suit their circumstances or preferences.
METHODS: Between April 2021 and May 2022, thirteen men and five women with MDR-TB, ten healthcare workers, and nine caregivers were purposively sampled to include a range of characteristics and experiences with DOT modalities. Data were generated through individual in-depth interviews and a smartphone messaging application (WhatsApp). Data coding was undertaken iteratively, and thematic analysis undertaken, supported by Nvivo.
RESULTS: Four themes emerged that reflected participants\' experiences with different DOT modalities, including stigma, efficiency, perceived risks of TB acquisition, and patient autonomy. vDOT was appreciated by patients for providing them with privacy and shielding them from stigmatisation associated with being seen in TB clinics or with community treatment supporters. vDOT was also seen as more efficient than CTS-DOT. Health workers acknowledged that it saved time, allowing them to attend to more patients, while many patients found vDOT more convenient and less expensive by removing the need to travel for in-person consultations. Health workers also appreciated vDOT because it reduced risks of TB acquisition by minimising exposure through virtual patient monitoring. Although many patients appreciated greater autonomy in managing their illness through vDOT, others preferred human contact or struggled with making video recordings. Most family members appreciated vDOT, although some resented feeling removed from the process of supporting loved ones.
CONCLUSIONS: vDOT was generally appreciated by MDR-TB patients, their family members and health workers as it addressed barriers to adherence which could contribute to improved treatment completion rates and reduced workplace exposure. However, patients should be offered an alternative to vDOT such as CTS-DOT if this modality does not suit their circumstances or preferences.
摘要：
背景：提高耐多药结核病（MDR-TB）患者的治疗成功率对于降低其发病率和死亡率至关重要，但是坚持提出了一个重要的挑战。基于视频的直接观察疗法（vDOT）可以提供依从性益处，同时解决与社区治疗支持者（CTS）-DOT相关的时间和成本负担。这项研究探索了患者的经验，家庭成员和医护人员在Eswatini中使用不同的DOT模式来支持依从性。
方法：在2021年4月至2022年5月期间，13名男性和5名女性患有耐多药结核病，十名医护人员,对9名护理人员进行了有目的地采样，以包括一系列DOT模式的特征和经验。数据是通过个人深入访谈和智能手机消息传递应用程序（WhatsApp）生成的。迭代地进行数据编码，并进行了专题分析，由Nvivo支持。
结果：出现了四个主题，反映了参与者对不同DOT模式的体验，包括污名,效率,结核病获得的感知风险，患者自主性vDOT受到患者的赞赏，因为它为他们提供了隐私，并使他们免受在结核病诊所或社区治疗支持者中看到的污名化。vDOT也被认为比CTS-DOT更有效。卫生工作者承认这节省了时间，让他们照顾更多的病人，虽然许多患者发现vDOT更方便，成本更低，因为无需亲自前往咨询。卫生工作者也赞赏vDOT，因为它通过虚拟患者监测最大限度地减少暴露，从而降低了结核病的风险。尽管许多患者赞赏通过vDOT管理疾病的更大自主权，其他人更喜欢与人接触，或者在制作视频录音方面苦苦挣扎。大多数家庭成员都喜欢vDOT，尽管一些怨恨的感觉从支持亲人的过程中移除。
结论：vDOT被耐多药结核病患者普遍认可，他们的家庭成员和卫生工作者，因为它解决了依从性障碍，这可能有助于提高治疗完成率和减少工作场所暴露。然而,如果这种方式不适合患者的情况或偏好,则应向患者提供vDOT的替代方案,如CTS-DOT.
方法：在2021年4月至2022年5月期间，13名男性和5名女性患有耐多药结核病，十名医护人员,对9名护理人员进行了有目的地采样，以包括一系列DOT模式的特征和经验。数据是通过个人深入访谈和智能手机消息传递应用程序（WhatsApp）生成的。迭代地进行数据编码，并进行了专题分析，由Nvivo支持。
结果：出现了四个主题，反映了参与者对不同DOT模式的体验，包括污名,效率,结核病获得的感知风险，患者自主性vDOT受到患者的赞赏，因为它为他们提供了隐私，并使他们免受在结核病诊所或社区治疗支持者中看到的污名化。vDOT也被认为比CTS-DOT更有效。卫生工作者承认这节省了时间，让他们照顾更多的病人，虽然许多患者发现vDOT更方便，成本更低，因为无需亲自前往咨询。卫生工作者也赞赏vDOT，因为它通过虚拟患者监测最大限度地减少暴露，从而降低了结核病的风险。尽管许多患者赞赏通过vDOT管理疾病的更大自主权，其他人更喜欢与人接触，或者在制作视频录音方面苦苦挣扎。大多数家庭成员都喜欢vDOT，尽管一些怨恨的感觉从支持亲人的过程中移除。
结论：vDOT被耐多药结核病患者普遍认可，他们的家庭成员和卫生工作者，因为它解决了依从性障碍，这可能有助于提高治疗完成率和减少工作场所暴露。然而,如果这种方式不适合患者的情况或偏好,则应向患者提供vDOT的替代方案,如CTS-DOT.
