OBJECTIVES

To qualitatively and quantitively synthesize the effects on medication adherence and clinical outcomes between Video-Observed Therapy (VOT) and Directly Observed Therapy (DOT) in tuberculosis (TB) patients.

METHODS

We systematically identified potential studies on MEDLINE (Ovid), EMBASE, CINAHL, and Cochrane from inception to September 17, 2020. Empirical studies were included if they focused on: (1) TB-infected population (2) VOT as an intervention (3) DOT as the comparison group; and (4) the assessment of patient’s medication adherence or clinical outcomes. Risk of bias was assessed using the revised tool to assess risk of bias in randomized trials version 2 (Randomized Controlled Trials - RCTs), Newcastle-Ottawa Scale (Cohort Studies), and Quality Assessment Tool from National Heart Lung and Blood Institute (Before-After Studies With No Control Group). Meta-analyses were conducted using Mantel-Haenszel methods with Rate Ratio (RR) and 95% Confidence Interval (95% CI) for dichotomous outcomes and generic inverse variance methods with Weighted Mean Difference (WMD) and 95% CI for continuous outcomes.

RESULTS

Among 204 records identified for abstract and title screening, 9 studies were included in the systematic review, with 1,091 patients in VOT group and 1,390 patients in DOT group. The studies enrolled in both active and latent young TB patients (mean/median age 32-48) and most of study participants were male (51-73%). Regarding quality assessment, 2 out of 3 RCTs and 3 out of 6 non-randomized studies were at low risk of bias. Compared to DOT, VOT was associated with improved medication adherence (RR=2.79, 95% CI=2.25-3.45, I²=25%), the proportion of doses observed (WMD=0.22, 95% CI=0.06-0.39, I²=96%), but not for treatment completion (RR=1.33, 95% CI=0.73-2.43, I²=98%) and clinical outcomes (RR=1.052, 95% CI=0.998-1.109, I²=0%).

CONCLUSIONS

VOT improved medication adherence but not treatment completion and did not result in an improvement in clinical outcomes compared to DOT in TB-infected patients.