Video Observed Therapy Device Improves Probability of Tuberculosis Therapy Adherence; A Randomised Clinical Trial at a TB Reference Clinic in Lagos

Abstract Background Video Observed Therapy (VOT) is a method of adherence monitoring where participants transmit digital images of their treatment intake to a central location for review; either synchronously or asynchronously. VOT presents an option that can be explored for developing countries like Nigeria with a high TB burden, thereby reducing the TB burden and ultimately eliminating it. Methods The study was a two-arm individually randomised clinical trial conducted by Nigeria Institute of Medical Research (NIMR) in Lagos, Nigeria. Participants (100) were recruited to this study and randomised into either treatment (VOT) or DOT (Directly Observed Therapy) as control. Data were collected through the NimCure mobile app and participant records. We compared treatment outcomes between VOT and DOT and assessed average treatment effects by adjusting for gender, location (state), and age. Results A high rate of 100% adherence to TB treatment was achieved in VOT (97%) and DOT (79%). More females than males achieved 100% adherence to VOT, while more males achieved 100% adherence to DOT. Rural dwellers achieved 100% adherence to both VOT and DOT. There was a varied distribution across all age groups. The average adherence, if all participants were to use VOT, would be 0.1709 (z = 2.23, p = 0.026) more than the average that would be if the participants did not use VOT. Conclusion VOT through the NimCure application achieved the adherence objective and showed that VOT can be used for effective remote monitoring and management of Tuberculosis in Nigeria. NimCure can therefore be recommended for use in low-income settings.