Video observed treatment for tuberculosis patients in Belarus.

Background and Aims: Directly observed treatment is recommended to improve adherence to tuberculosis (TB) treatment. However, daily treatment observation presents challenges for both patients and health care staff. Video observed treatment (VOT) can help bridge the gap between patients and health services and promote adherence. In 2015 the Ministry of Health of Belarus, with support from the World Health Organization (WHO), piloted VOT for TB patients in the capital, Minsk. The intervention was aligned to the digital health target product profiles developed by WHO/ERS (2015) with aim of testing the feasibility and performance of VOT in a programme setting. Methods: A smartphone application was created and linked to the national electronic TB register. Patients were provided with smartphones with internet access, and shown how to record and transmit video files to trained clinic staff. Following an initial pilot project VOT was expanded countrywide with Global Fund support. Results: Between 1 January 2016 and 1 February 2017, 105 patients were recruited: median age 32 years (range:18-67); 68% male; 62% multidrug- or extensively-drug resistant TB. Of 4,797 VOT episodes registered, 94% were of good quality. No smartphone was lost; 14 of 15 (93%) patients who completed treatment for drug-susceptible TB had a successful outcome. Conclusions: Preliminary data demonstrate high levels of patient acceptability and treatment adherence using VOT among a diverse mix of TB patients and staff in all six regions of Belarus. The experience gained can promote this patient-centered approach for TB patients with comorbidities (e.g. HIV, substance abuse) and complex social issues.