Video observation transforms the treatment of tuberculosis in Moldova
It has been more than half a year since Maria* treated herself for tuberculosis and since she came back to work at the Chisinau high school where she is a teacher.
Every year, like all employees in the field of education, she underwent a medical check-up, including a radiograph of the chest. In the summer of 2016, she followed the same routine. The result – healthy. After just a few months, on New Year's Eve, Maria remembers having unbearable chest pains. She blamed them on stress, especially since after a while the pains stopped.
In March 2017, a sudden and intense pain that "pressed her heart" made her call the ambulance. The physicians told her it was heart related, but nothing serious. In April, during Easter, she went to the countryside, to her parents, but her health was declining every day. She went to a doctor in the district where she learned that her pains are lungs-related, because of an untreated pneumonia. Back in Chisinau, she made further investigations, and ... was diagnosed with tuberculosis of the lungs without bacilli elimination.
"I was shocked. I'm from a middle-income family, even my doctor told me that tuberculosis is the disease of the poor. They told me that I had been ill for some time and that I had to go to the hospital urgently, temporarily giving up on my job."
The doctors even told me: "Better quit your job! You will not even be able to come to work after such a diagnosis."
For almost a month, she was hospitalized. Maria took a fistful of pills every single day. They were big and bitter. Doctors were going to send her home when she was told that she would have to follow the same strictly supervised treatment for another six months and come to the local clinic five days a week, so the doctor would be sure that she follows the treatment. Going to the doctor daily was not something to be happy about, but she was determined to recover.
Until being sent home from the hospital, doctors proposed her to be part of a UNDP study – video observance of treatment. By being randomly picked she was included in the group of video-observed treatment, their results being compared with those of a group who were receiving the treatment directly observed at home or at the clinic.
She was given special equipment – a tablet. Every day, she filmed herself taking her pills, sending video to the nurse, communicating via phone about her feelings during treatment: "I reacted positively to this study. I took a pill, then had water, opened my mouth, and continued until I took all the pills.”
"I read a lot about the illness and the life after you find out you have tuberculosis. It is important to follow the doctor’s advice." Maria recalls that the doctor in the hospital, seeing her even reading the clinical protocols, teased her: “You’d better read a prayer book rather than a medicine one."
Mary says she met many patients who thought tuberculosis could not be treated, a disease for life, and others who thought they did not need to go through all of their treatment process. She believes there is still much to be done for people to understand that personal responsibility helps those affected to successfully overcome the disease.
Altogether, 175 people affected by tuberculosis were included in the UNDP research, conducted in partnership with the Ministry of Health, Labor and Social Protection, the AFI NGO (Association for Health and Community Development), the Center for Health Policies and Analyzes and Behavioral Insights Team (United Kingdom).
Patients were randomly assigned to two groups: the treatment of one group of patients was routinely directly observed (DOT – directly observed treatment) and the other group – as was the case of Mary – was observed remotely (VOT– video observed treatment). Preliminary results show that the adherence level for VOT was 87%, double compared the control group, DOT – 43%.
"The benefit of virtually observed treatment is saving time and money. People reported a higher level of satisfaction compared with their peers who went to the local clinic to take the medicines in front of the medical staff," says Svetlana Doltu, director of the Public Health Programme at AFI. Thanks to the results obtained in the study and with the support of the Global Fund, another 10 districts will pilot video observance of tuberculosis treatment.
Another advantage of the VOT method is that it provides more personal space for the patients: "People have not gone through the fear of being seen by neighbors or be known to go to the doctor daily, considering people affected by tuberculosis as well as their family are being stigmatized," says Svetlana Doltu.
Maria felt from personal experience what stigma towards the people that suffer from tuberculosis means: "I was devasted to be out of my job for so many months. Some colleagues looked at me differently. The confidentiality of the diagnosis was not respected, the whole school knew, from small to large."
Maria was determined and came back to work, despite the circumstances: "I feel part of the team again. I'm not ashamed of anything, there is no way to avoid the bacilli. It's a myth that it only affects certain categories of society."
Now, she's taking more care of her health, investing in a strict diet, doing regular checks. She wants a baby ... or three.
"My husband and family supported me. It was a life lesson that made me stronger," concludes Maria.
Since 2017, UNDP is procuring medicines and tests for the national tuberculosis control and prophylaxis program.
"I think this is a very good practice, although it is an alternative procedure, the provision of medicines being the responsibility of the state through its procurement mechanisms. Significant results have been achieved, with international purchases of essential drugs of vital importance, savings in the public budget, increasing the number of people receiving free and quality medicines in compliance with the highest international standards," says Svetlana Doltu of AFI.
"UNDP has an impeccable reputation, rapid procurement mechanisms, emphasizes quality and the best price being one of the most transparent international organizations in the world," concludes Victoria Mereuta, manager of UNDP project “Procurement Support Services for the Ministry of Health, Labor and Social Protection”.
According to data for the previous year of the Ministry of Health, Labor and Social Protection, 3,358 people were affected by tuberculosis and 320 died.
The treatment of sensitive tuberculosis lasts 6-8 months, and of the resistant one – up to two years, in this case the person is taking 11-12 pills that destroy the bacillus, besides those that mitigate the possible side effects. In the Republic of Moldova, tuberculosis treatment is free of charge and covered by public funds and sources provided by development partners.
* The name was changed at the person's request.