A Systematic Review of Video-Observed Therapy for Isoniazid Preventive Therapy Adherence Among Child Contacts of Tuberculosis Patients in South Africa, 2018

Child contacts of tuberculosis (TB) patients are at high risk of developing the disease. Isoniazid preventive therapy (IPT) is a key intervention to reduce this risk, but its effectiveness is undermined by poor adherence. Video-observed therapy (VOT) is a digital health intervention that may support adherence monitoring, but its application and effectiveness for IPT among child contacts in high-burden settings like South Africa require systematic assessment. This systematic review aimed to synthesise evidence on the use of video-observed therapy to monitor and support adherence to isoniazid preventive therapy among child contacts of TB patients in Johannesburg, South Africa. It sought to determine reported adherence levels, identify barriers and facilitators to VOT implementation, and evaluate its feasibility and acceptability. A systematic search was conducted across multiple electronic databases. Predefined inclusion and exclusion criteria were applied to select studies focusing on VOT for IPT adherence in the specified population and setting. Study quality was assessed using appropriate critical appraisal tools. Data were extracted and synthesised thematically. The review identified a limited number of studies meeting the inclusion criteria. The available evidence suggests that VOT is a feasible and acceptable method for monitoring IPT adherence in this context. A key finding was that caregiver support was a critical determinant of successful VOT implementation, directly influencing observed adherence rates. Video-observed therapy shows promise as a tool for supporting IPT adherence among child contacts of TB patients in urban South African settings. However, the current evidence base is limited. More robust, large-scale studies are needed to conclusively determine its effectiveness and cost-effectiveness compared to standard directly observed therapy. Future research should prioritise well-designed implementation studies and randomised controlled trials. Programmatic implementation of VOT should be accompanied by comprehensive training for healthcare workers and caregivers, and by strategies to address technological and social barriers. tuberculosis, isoniazid preventive therapy, treatment adherence, video-observed therapy, child contacts, South Africa, systematic review. This review consolidates the available evidence on video-observed therapy for isoniazid preventive therapy adherence in a high-priority population in South Africa, highlighting critical evidence gaps and providing direction for future research and programme implementation.