Paper short abstract:

MDR-TB patient's experience and treatment adherence between DOT in Kathmandu and VOT in London. How technology shapes treatment experience and meaning, in a context of vertical health policy that questions trust between patients and healthcare professionals.

Paper long abstract:

Multi-Drug Resistant Tuberculosis (MDR-TB) requires twenty months or longer treatment, often filled with side effects so painful that patients sometimes suspend their treatment. Directly-Observed Treatment (DOT) is the backbone of the World Health Organisation (WHO) policy implemented since the 1990s in the effort to ensure tuberculosis treatment worldwide. The policy suggests that patients have to be observed taking their medications, which in many countries, like Nepal, entails that patients are required to visit a healthcare centre daily to take their medications in front a healthcare professional. A routine which MDR-TB patients struggle to follow due to the painful side effects those same medications give them, other than the obvious inconvenience in time and costs. Recently, a digital health intervention called Video Observed Treatment (VOT) has been developed to support a more patient-centred approach to DOTS, allowing patients to record videos of themselves online taking medications, without having to go to a healthcare facility. This technology, which is available now only for a limited number of patients in contexts such as London, gives the opportunity to patients to manage their time and side effects by splitting the daily dosage of medication and taking them in the most convenient time and place.

Reflecting on two ethnographic fieldwork, in Kathmandu (Nepal) and London (UK), this proposal explores MDR-TB treatment adherence in the 21st century, and it questions the opportunity of technology and how patients experience it in a context, like DOTS, where trust is put to a test, if not lacking.