7th SA TB Conference 2022 Oral Presentation

Track 3: Implementation/Health systems

Authors: Siyabonga Myeni, Munira Khan, Suzanne Staples

Video Observed Therapy (VOT) is an innovative digital treatment support technology that employs live or recorded video monitoring dosing via a smartphone, tablet or computer.


Among VOT implementors and MDR-TB patients on a TB clinical trial in KwaZulu-Natal, South Africa:

  • To measure acceptability and feasibility of VOT,
  • To identify barriers and enablers


  • A complementary concurrent mixed-methods design was used:
    • Quantitative survey captured participants’ demographic information, access to and ability to use technology and the usage of VOT.
    • Qualitative component consisted of in-depth interviews with implementors to gather perceptions and experiences and patient focus group discussions for patient experiences.
  • The Technology Acceptance Model provided the framework for data collection tools

Results: Patients

  • Twenty-nine patients participated:
    • 80% were male
    • Aged 25 – 34 (41%), 35 – 44 (38%) and 45 – 54 (21%) years.
  • Enablers supporting implementation:
    • 92% agreed that using VOT would help them complete treatment.
    • 97% felt more connected to their healthcare provider through VOT.
    • VOT also provided patients with greater flexibility compared to DOT.
  • Barriers to implementation:
    • Poor mobile network coverage in rural areas,
    • Load shedding,
    • Loss of VOT-allocated mobile devices through crime.

Results: VOT Implementors

  • Seventeen VOT implementors participated in the study who were all THINK employees.
  • Clinical VOT implementors reported that:
    • VOT enabled the provision of better support and counselling (71%) and easy identification of poorly-adherent patients (82%).
    • VOT provided more reliable treatment support data compared to DOT; which further informed clinical management decisions.


  • This study showed that VOT was an acceptable and feasible treatment treatment support strategy both amongst implementors and patients.
  • However, the use of VOT was limited to a clinical trial setting within THINK and use in public sector settings and further implementation science studies are therefore needed.