Feasibility of tuberculosis treatment monitoring by video directly observed therapy: a binational pilot study

Abstract

Background: Although directly observed therapy (DOT) is recommended worldwide for monitoring anti-tuberculosis treatment, transportation and personnel requirements limit its use.

Objective: To evaluate the feasibility and acceptability of 'video DOT' (VDOT), which allows patients to record and transmit medication ingestion via videos watched remotely by health care providers to document adherence.

Methods: We conducted a single-arm trial among tuberculosis (TB) patients in San Diego, California, USA, (n = 43) and Tijuana, Mexico (n = 9) to represent high- and low-resource settings. Pre-/post-treatment interviews assessed participant characteristics and experiences. Adherence was defined as the proportion of observed doses to expected doses.

Results: The mean age was 37 years (range 18-86), 50% were male, and 88% were non-Caucasian. The mean duration of VDOT use was 5.5 months (range 1-11). Adherence was similar in San Diego (93%) and Tijuana (96%). Compared to time on in-person DOT, 92% preferred VDOT, 81% thought VDOT was more confidential, 89% never/rarely had problems recording videos, and 100% would recommend VDOT to others. Seven (13%) participants were returned to in-person DOT and six (12%) additional participants had their phones lost, broken or stolen.

Conclusions: VDOT was feasible and acceptable, with high adherence in both high- and low-resource settings. Efficacy and cost-effectiveness studies are needed.

Figure 1

Video Directly Observed Therapy (VDOT) flow diagram

Figure 2

Tuberculosis medication adherence rates among participants in San Diego, CA and Tijuana, Baja California, Mexico (n=51)

Figure 3

Level of comfort using smartphone functions before and after having tuberculosis treatment monitored using the VDOT System. *Change in comfort score from baseline to follow-up was statistically significant (p≤0.05). ** Measured on a 10 point scale.