Asynchronous Video Directly Observed Therapy to Monitor Short-Course Latent Tuberculosis Infection Treatment: Results of a Randomized Controlled Trial

Abstract

Background Observing medication ingestion through self-recorded videos (Video Directly Observed Therapy [VDOT]) has been shown to be a cost-effective alternative to in-person DOT for monitoring adherence to treatment for tuberculosis (TB) disease. VDOT could be a useful tool to monitor short-course latent TB infection (LTBI) treatment. Methods We conducted a prospective, randomized controlled trial comparing VDOT (intervention) to clinic-based DOT (control) among patients newly diagnosed with LTBI who agreed to a once-weekly, 3-month isoniazid and rifapentine treatment regimen (3HP). Study outcomes were treatment completion and patient satisfaction. We also assessed costs. Pre- and post-treatment interviews were conducted. Results Between March 2016 and December 2019, 130 participants were assigned to VDOT (n=68) or DOT (n=62). Treatment completion (73.5% vs. 69.4%, p=0.70) and satisfaction with treatment monitoring (92.1% vs. 86.7%, p=0.39) were slightly higher in the intervention compared to the control group, but neither were statistically significant. VDOT cost less per patient (median=$230; range: $182-$393) compared to DOT (median=$312; range: $246-$592) if participants used their own smartphone. Conclusions While both groups reported high treatment satisfaction, VDOT was not associated with higher LTBI treatment completion. However, VDOT cost less than DOT. Volunteer bias might have reduced the observed effect since patients opposed to any treatment monitoring could have opted for alternative, unobserved regimens. Given similar outcomes and lower cost, VDOT may be useful for treatment monitoring when in-person observation is prohibited or unavailable, such as during a respiratory disease outbreak. The trial was registered at the National Institutes of Health (ClinicalTrials.gov) #NTC02641106