Behavioural insights and tuberculosis

In 2017, 1.7 million people died from tuberculosis worldwide, even though effective treatments exist. Moldova has the highest incidence of tuberculosis in Europe.

The World Health Organization recommends directly observed treatment (DOT), where patients are observed by a doctor or nurse as they take their medication. However, although this approach can result in some patients taking the medication for longer, for others the requirement to visit a clinic acts as a barrier.

Two behavioural insights may be useful in this regard. Even very small barriers (i.e. ‘frictions’) that require effort to overcome can prevent people from doing something. These are called friction costs.

Additionally, by making the process of taking medication as easy as possible, we can increase the likelihood that people will adhere to their treatment.

We piloted an approach called virtually observed treatment (VOT). Instead of having to travel to a clinic, patients could record a video of themselves taking their pills at a time convenient to them.

The VOT scheme increased observed adherence from 44 per cent for DOT patients to 84 per cent for VOT patients. The Moldovan Ministry of Health now plans to scale access to VOT across the country.