Short and long-term outcomes of video observed treatment in tuberculosis patients, the Republic of Moldova.

INTRODUCTION: The Republic of Moldova is among the 18 high priority countries for tuberculosis (TB) in Europe. This study compared adherence and short and long-term TB treatment outcomes for TB patients who experienced asynchronous Video Observed Treatment (aVOT) during three months of outpatient treatment versus Directly Observed Treatment (DOT) in operational conditions in 2016-2017 in Chisinau. METHODOLOGY: We used secondary data from the 2016-2017 Randomized Clinical Trial (RCT) that piloted the aVOT Strategy in Chisinau and data from the national TB register. Relative risk was selected as a measure of association in analysis of treatment strategies (aVOT and DOT under operational conditions) and short and long-term treatment outcomes. RESULTS: From 647 TB patients included in the study, 169 followed the treatment strategy in the RCT (83 in aVOT and 86 in DOT) and 478 were on DOT in operational conditions. Those in aVOT were more likely to have favourable short-term outcome than patients with DOT in operational conditions (RR 0.07; p < 0.001). TB recurrence as an indicator for the long-term outcome, was observed in group with DOT in operational conditions (40 cases, p = 0.006). CONCLUSIONS: This study demonstrated that the aVOT treatment strategy was associated with better adherence and both short and long-term TB treatment favourable outcomes. aVOT as a new patient-centred approach supporting TB patients on improving treatment adherence and outcomes might be recommended as an alternative to DOT strategy in the Republic of Moldova.

Video-observed therapy and medication adherence for tuberculosis patients: randomised controlled trial in Moldova.

INTRODUCTION: The effectiveness of video-observed therapy (VOT) for treating tuberculosis (TB) has not been measured in low- and middle-income countries (LMICs), where >95% of TB cases and deaths occur. In this study, we analyse the effectiveness and patient cost-difference of VOT compared to clinic-based directly observed therapy (DOT) in improving medication adherence in Moldova, a LMIC in Eastern Europe. METHODS: The study was a two-arm individually randomised trial with 197 TB patients (n=99 DOT control group; n=98 VOT treatment group; multidrug-resistant TB cases were excluded). The primary outcome was observed medication adherence, measured by the number of days that a patient failed to be observed adhering to medication for every 2-week period during the course of their treatment. RESULTS: VOT significantly decreased nonadherence by 4 days (95% CI 3.35-4.67 days, p<0.01) per 2-week period: 5.24 days missed per 2-week period for DOT and 1.29 days for VOT. VOT patients spent MDL 504 (∼EUR 25) (95% CI MDL 277-730, p<0.01) and 58 h (95% CI 48-68 h, p<0.01) less on their treatment. In addition, VOT increased self-reported satisfaction with treatment. We found no significant results pertaining to treatment success, patient wellbeing or patient employment status and some evidence of an increase in side-effects. DISCUSSION: In this trial, VOT increased observed medication adherence for TB patients in Moldova, a LMIC, when compared to clinic-based DOT. Additionally, VOT significantly reduced the time and money patients spent on their treatment.

Alone but better off? Adult child migration and health of elderly parents in Moldova.

Increasing labor migration and simultaneous aging of societies are two important demographic developments many poor countries face. Elderly people who are left behind may experience a decrease in welfare when their children migrate. This paper investigates the effect of migration on various dimensions of elderly health using unique data from Moldova, which has one of the highest emigration rates in the world. We find positive migration effects on body mass index (BMI), mobility and self-reported health. No effects are found on depression and cognitive capacity. We find evidence that these positive outcomes are linked to an income effect which leads to improvements in diet and identify a reallocation of time use from subsistence farming to leisure and sleep which may have further beneficial effects. These positive effects seem to compensate the elderly for decreasing social contact with their migrant family members.