“Self-administered therapy”, or SAT, is an approach to treatment that we have been implementing at our tuberculosis (TB) project in Zhytomyr.
As you’d imagine from the name, SAT involves patients taking drugs on their own, without medical supervision. This is a newer approach in Ukraine when it comes to TB.
Directly observed treatment
TB treatment requires patients to take multiple pills consistently and frequently – sometimes two or three times every day. It is very important that patients do not miss even a single day of treatment, so medics have followed an approach of “directly observed treatment” (DOT) for a long time.
[DOT] can also be incredibly taxing on patients who struggle to arrange their lives around hospital stays and doctor’s visits for months
Under the DOT approach, patients are supervised as they swallow their tablets. This is a great option for some patients and ensures that they are correction adhering to their treatment.
However, it can also be incredibly taxing on patients who struggle to arrange their lives around hospital stays and doctor’s visits for months while they complete treatment.
DOT is made even more difficult in this region, where patients may have difficulty in accessing facilities where they can receive their treatment.
Last year we did an assessment that found that some facilities lacked the staff and equipment to administer TB care. Some facilities do not offer psychological support or consultations to make sure patients are informed about their treatment, which is key to ensuring patient adherence, and some had limited working hours.
As a result, appropriate services where patients can access treatment can be multiple kilometres away from their homes, forcing them to spend time and money on travelling every day. We know this can disrupt their family lives and their working lives.
We also know that listening to individual patients' needs and adapting their treatment options accordingly improves adherence to treatment.
Seeing their joy and hearing their thanks at the end of their treatment is truly rewarding
So, two years ago, when MSF started working in Zhytomyr, SAT was a necessary option for TB patients here, not only because DOT was not feasible but because empowered patients are reliable and able to manage their own treatment.
Under the SAT model, patients are able to receive up to 10 days of TB medication to administer themselves over those days. This can be part of a long-term treatment plan, or can even be adapted and used together with DOT to allow patients to go on holiday, for example.
So far, we are positive about the results. We have celebrated 18 cured patients whose treatment followed the SAT model in this region.
Now I feel optimistic about the potential for this model to be replicated elsewhere, in places where DOT may be constrained and where SAT could be appropriate for the individual patient.
The most important thing is that we match patients to the right treatment option for them. Every patient has different needs, and I am proud that for some patients, SAT is an empowering option that we are able to offer.
My job centres around putting the patient first and listening to their individual needs, so seeing their joy and hearing their thanks at the end of their treatment is truly rewarding.