Tuberculosis in Moldova

Tuberculosis (TB) still causes the deaths of 1.6 million people each year globally, despite the presence of an effective treatment. The barrier to people accessing treatment is predominantly behavioural: the treatment often requires a six-month course, which has to be taken even after symptoms are not visible.

To overcome this barrier, the World Health Organization recommends directly observed treatment (DOT), where patients are observed by a doctor or nurse as they take their medication. This approach has had mixed results – it can result in some patients taking the medication for longer, but for others the requirement to visit a clinic acts as an additional barrier.

Moldova has one of the highest rates of multi-drug-resistant TB in the world and follows DOT. In partnership with the United Nations Development Programme, the Moldovan Ministry of Health, and Act for Involvement, BIT created a virtual form of DOT (called VOT) where patients were able to record videos of themselves taking their medication. These videos could then be submitted to a medical professional for verification, removing the need for the patient to go to a clinic.

Using a small-scale randomised control trial, we found that VOT 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.