<i>Notes from the Field</i>: Use of Asynchronous Video Directly Observed Therapy for Treatment of Tuberculosis and Latent Tuberculosis Infection in a Long-Term–Care Facility ― Puerto Rico, 2016–2017

Olano-Soler, Henry; Thomas, Dana L.; Joglar, Olga; Rios, Katrina; Torres-Rodríguez, Milton; Duran-Guzman, Greduvel; Chorba, Terence

doi:10.15585/mmwr.mm6650a5

Cited by 19 publications

(18 citation statements)

References 5 publications

(6 reference statements)

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“…More recently, smartphone apps have been developed that enable video clips to be recorded and forwarded for later viewing (asynchronous VOT) 14 . Asynchronous VOT is currently used in some clinics in the USA and has high reported levels of patient acceptability, decreased costs compared with DOT, and programmatic evidence of effectiveness 14, 15, 16, 17, 18. WHO therefore conditionally recommended VOT as an alternative to DOT in 2017, but the evidence was graded weak due to few randomised controlled trials available 4 .…”

Section: Introductionmentioning

confidence: 99%

Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial

et al. 2019

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SummaryBackgroundDirectly observed treatment (DOT) has been the standard of care for tuberculosis since the early 1990s, but it is inconvenient for patients and service providers. Video-observed therapy (VOT) has been conditionally recommended by WHO as an alternative to DOT. We tested whether levels of treatment observation were improved with VOT.MethodsWe did a multicentre, analyst-blinded, randomised controlled superiority trial in 22 clinics in England (UK). Eligible participants were patients aged at least 16 years with active pulmonary or non-pulmonary tuberculosis who were eligible for DOT according to local guidance. Exclusion criteria included patients who did not have access to charging a smartphone. We randomly assigned participants to either VOT (daily remote observation using a smartphone app) or DOT (observations done three to five times per week in the home, community, or clinic settings). Randomisation was done by the SealedEnvelope service using minimisation. DOT involved treatment observation by a health-care or lay worker, with any remaining daily doses self-administered. VOT was provided by a centralised service in London. Patients were trained to record and send videos of every dose ingested 7 days per week using a smartphone app. Trained treatment observers viewed these videos through a password-protected website. Patients were also encouraged to report adverse drug events on the videos. Smartphones and data plans were provided free of charge by study investigators. DOT or VOT observation records were completed by observers until treatment or study end. The primary outcome was completion of 80% or more scheduled treatment observations over the first 2 months following enrolment. Intention-to-treat (ITT) and restricted (including only patients completing at least 1 week of observation on allocated arm) analyses were done. Superiority was determined by a 15% difference in the proportion of patients with the primary outcome (60% vs 75%). This trial is registered with the International Standard Randomised Controlled Trials Number registry, number ISRCTN26184967.FindingsBetween Sept 1, 2014, and Oct 1, 2016, we randomly assigned 226 patients; 112 to VOT and 114 to DOT. Overall, 131 (58%) patients had a history of homelessness, imprisonment, drug use, alcohol problems or mental health problems. In the ITT analysis, 78 (70%) of 112 patients on VOT achieved ≥80% scheduled observations successfully completed during the first 2 months compared with 35 (31%) of 114 on DOT (adjusted odds ratio [OR] 5·48, 95% CI 3·10–9·68; p<0·0001). In the restricted analysis, 78 (77%) of 101 patients on VOT achieved the primary outcome compared with 35 (63%) of 56 on DOT (adjusted OR 2·52; 95% CI 1·17–5·54; p=0·017). Stomach pain, nausea, and vomiting were the most common adverse events reported (in 16 [14%] of 112 on VOT and nine [8%] of 114 on DOT).InterpretationVOT was a more effective approach to observation of tuberculosis treatment than DOT. VOT is likely to be preferable to DOT for many patients across a broad ra...

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Section: Introductionmentioning

confidence: 99%

Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial

et al. 2019

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“…VDOT can overcome the limitations of in-person DOT at the patient and health system levels. For example, VDOT studies have shown that the distance barrier is mostly eliminated [24][25][26], patients have greater autonomy to choose when and where to take their medications [25,27], the costs of travel are minimised [24,28], and providers can support a higher number of patients, thus increasing the health system efficiency [24,29].…”

Section: Introductionmentioning

confidence: 99%

Video directly observed therapy for supporting and monitoring adherence to tuberculosis treatment in Uganda: a pilot cohort study

et al. 2020

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IntroductionNonadherence to treatment remains an obstacle to tuberculosis (TB) control worldwide. The aim of this study was to evaluate the feasibility of using video directly observed therapy (VDOT) for supporting TB treatment adherence in Uganda.MethodsFrom May to December 2018, we conducted a pilot cohort study at a TB clinic in Kampala City. We enrolled patients aged 18–65 years with ≥3 months remaining of their TB treatment. Participants were trained to use a smartphone app to record videos of medication intake and submit them to a secured system. Trained health workers logged into the system to watch the submitted videos. The primary outcome was adherence measured as the fraction of expected doses observed (FEDO). In a secondary analysis, we examined differences in FEDO by sex, age, phone ownership, duration of follow-up, reasons for missed videos and patients' satisfaction at study exit.ResultsOf 52 patients enrolled, 50 were analysed. 28 (56%) were male, the mean age was 31 years (range 19–50 years) and 35 (70%) owned smartphones. Of the 5150 videos expected, 4231 (82.2%) were received. The median FEDO was 85% (interquartile range 66%–94%) and this significantly differed by follow-up duration. Phone malfunction, uncharged battery and VDOT app malfunctions were the commonest reasons for missed videos. 92% of patients reported being very satisfied with using VDOT.ConclusionVDOT was feasible and acceptable for monitoring and supporting TB treatment. It resulted in high levels of adherence, suggesting that digital technology holds promise in improving patient monitoring in Uganda.

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“…Se han publicado otros estudios en América Latina (ej., México, Brasil y Puerto Rico) para evaluar el uso, viabilidad o rentabilidad de VDOT y otras tecnologías digitales para pacientes con tuberculosis (14,15,16) . Este estudio fue el primer estudio de evaluar las características de VDOT para pacientes con tuberculosis en el Perú.…”

Section: Discussionunclassified

Video supervised treatment of patients with pulmonary tuberculosis in a health care center in Lima. Pilot study

et al. 2022

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Objetivo: Describir las características de la implementación del tratamiento supervisado por video (VDOT) en pacientes con tuberculosis en un establecimiento de salud de la seguridad social del primer nivel de atención en Perú (EsSalud). Material y métodos: Estudio observacional, descriptivo. Los pacientes fueron enrolados de forma prospectiva de 18/09/2018 al 24/09/2019. Ocho de los nueve pacientes seguidos completaron el tratamiento VDOT. Un paciente fue transferido a otro establecimiento de salud antes de terminar el seguimiento. Una enfermera entrenada de Socios En Salud gestionó las 727 video llamadas. Resultados: Se obtuvo una adherencia al tratamiento del 100%. Conclusiones: La estrategia VDOT sería una modalidad alternativa útil en pacientes con tuberculosis sensible.

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Notes from the Field: Use of Asynchronous Video Directly Observed Therapy for Treatment of Tuberculosis and Latent Tuberculosis Infection in a Long-Term–Care Facility ― Puerto Rico, 2016–2017

Cited by 19 publications

References 5 publications

Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial

Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial

Video directly observed therapy for supporting and monitoring adherence to tuberculosis treatment in Uganda: a pilot cohort study

Video supervised treatment of patients with pulmonary tuberculosis in a health care center in Lima. Pilot study

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