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

Garfein, Richard S.; Collins, Kelly; Muñoz, Fátima; Moser, Kathleen; Cerecer-Callu, Paris; Raab, F; Rios, Phillip; Flick, Allison; Zúñiga, María Luisa; Cuevas-Mota, Jazmine; Liang, Krystal; Rangel, Gudelia; Burgos, José Luis; Rodwell, Timothy C.; Patrick, Kevin

doi:10.5588/ijtld.14.0923

Cited by 128 publications

(152 citation statements)

References 8 publications

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“…Our system allows patients to submit high resolution videos, at a time of their choosing, and grants the healthcare worker the flexibility to review all the days' videos in a single session at a time that is convenient. One other published study has been carried out that used a system of smartphone transmission of images and text reminders similar to ours 25. This was shown to be feasible and acceptable in a small group of patients with TB in USA and Mexico, the majority of whom were also comfortable at baseline with various aspects of the technology and so were likely somewhat selected.…”

Section: Discussionmentioning

confidence: 90%

Prospective single-arm interventional pilot study to assess a smartphone-based system for measuring and supporting adherence to medication

et al. 2016

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ObjectivesSuboptimal medication adherence for infectious diseases such as tuberculosis (TB) results in poor clinical outcomes and ongoing infectivity. Directly observed therapy (DOT) is now standard of care for TB treatment monitoring but has a number of limitations. We aimed to develop and evaluate a smartphone-based system to facilitate remotely observed therapy via transmission of videos rather than in-person observation.DesignWe developed an integrated smartphone and web-based system (Mobile Interactive Supervised Therapy, MIST) to provide regular medication reminders and facilitate video recording of pill ingestion at predetermined timings each day, for upload and later review by a healthcare worker. We evaluated the system in a single arm, prospective study of adherence to a dietary supplement. Healthy volunteers were recruited through an online portal. Entry criteria included age ≥21 and owning an iOS or Android-based device. Participants took a dietary supplement pill once, twice or three-times a day for 2 months. We instructed them to video each pill taking episode using the system.OutcomeAdherence as measured by the smartphone system and by pill count.Results42 eligible participants were recruited (median age 24; 86% students). Videos were classified as received—confirmed pill intake (3475, 82.7% of the 4200 videos expected), received—uncertain pill intake (16, <1%), received—fake pill intake (31, <1%), not received—technical issues (223, 5.3%) or not received—assumed non-adherence (455, 10.8%). Overall median estimated participant adherence by MIST was 90.0%, similar to that obtained by pill count (93.8%). There was a good relationship between participant adherence as measured by MIST and by pill count (Spearmans rs 0.66, p<0.001).ConclusionsWe have demonstrated the feasibility, acceptability and accuracy of a smartphone-based adherence support and monitoring system. The system has the potential to supplement and support the provision of DOT for TB and also to improve adherence in other conditions such as HIV and hepatitis C.

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Section: Discussionmentioning

confidence: 90%

Prospective single-arm interventional pilot study to assess a smartphone-based system for measuring and supporting adherence to medication

et al. 2016

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“…26 Some health departments have also found web-based video, mobile technology, or other devices to be effective ways to conduct DOT. 9, 27 …”

Section: Latent Tuberculosis Infection Treatmentmentioning

confidence: 99%

Ce

Parmer

Allen

Walton

2017

AJN, American Journal of Nursing

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Nurses play a critical role in the diagnosis and treatment of tuberculosis and in the prevention of tuberculosis transmission through infection control practices. To eliminate tuberculosis in the United States, however, an expanded approach to testing and treating people with latent tuberculosis infection must be implemented. Recently, the U.S. Preventive Services Task Force (USPSTF) issued a new recommendation statement on latent tuberculosis infection testing that expands nurses’ opportunities to identify at-risk populations for tuberculosis prevention. In combination with newer testing methodologies and shorter treatment regimens, implementation of the USPSTF recommendation has the potential to remove previously existing barriers to screening and treatment of both patients and health care providers. This article provides a general overview of tuberculosis transmission, pathogenesis, and epidemiology; presents preventive care recommendations for targeted testing among high-risk groups; and discusses the USPSTF recommendation’s applicability to public health and primary care practice in the United States.

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“…[8,15] Staff experienced with the two initiatives were consulted to inform the implementation plan, and the few technological issues encountered were easily resolved because staff experienced in using the software for [19], and providing additional software options may continue to make supervision of treatment more convenient for patients.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Using Video Technology to Increase Treatment Completion for Patients With Latent Tuberculosis Infection on 3-Month Isoniazid and Rifapentine: An Implementation Study (Preprint)

Lam¹,

Pilote²,

Haque³

et al. 2018

Preprint

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BACKGROUND Since January 2013, the New York City (NYC) Health Department Tuberculosis (TB) Program has offered persons diagnosed with latent TB infection (LTBI) the 3-month, once-weekly isoniazid and rifapentine (3HP) treatment regimen. Patients on this treatment are monitored in-person under directly observed therapy (DOT). To address patient and provider barriers to in-person DOT, we piloted the use of a videoconferencing software app to remotely conduct synchronous DOT (video directly observed therapy; VDOT) for patients on 3HP. OBJECTIVE The objective of our study was to evaluate the implementation of VDOT for patients on 3HP and to assess whether treatment completion for these patients increased when they were monitored using VDOT compared with that using the standard in-person DOT. METHODS Between February and October 2015, patients diagnosed with LTBI at any of the four NYC Health Department TB clinics who met eligibility criteria for treatment with 3HP under VDOT (V3HP) were followed until 16 weeks after treatment initiation, with treatment completion defined as ingestion of 11 doses within 16 weeks. Treatment completion of patients on V3HP was compared with that of patients on 3HP under clinic-based, in-person DOT who were part of a prior study in 2013. Furthermore, outcomes of video sessions with V3HP patients were collected and analyzed. RESULTS During the study period, 70% (50/71) of eligible patients were placed on V3HP. Treatment completion among V3HP patients was 88% (44/50) compared with 64.9% (196/302) among 3HP patients on clinic DOT (P<.001). A total of 360 video sessions were conducted for V3HP patients with a median of 8 (range: 1-11) sessions per patient and a median time of 4 (range: 1-59) minutes per session. Adherence issues (eg, >15 minutes late) during video sessions occurred 104 times. No major side effects were reported by V3HP patients. CONCLUSIONS The NYC TB program observed higher treatment completion with VDOT than that previously seen with clinic DOT among patients on 3HP. Expanding the use of VDOT may improve treatment completion and corresponding outcomes for patients with LTBI.

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

Cited by 128 publications

References 8 publications

Prospective single-arm interventional pilot study to assess a smartphone-based system for measuring and supporting adherence to medication

Prospective single-arm interventional pilot study to assess a smartphone-based system for measuring and supporting adherence to medication

Ce

Using Video Technology to Increase Treatment Completion for Patients With Latent Tuberculosis Infection on 3-Month Isoniazid and Rifapentine: An Implementation Study (Preprint)

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