Recommendations for Use of Video Directly Observed Therapy During Tuberculosis Treatment — United States, 2023

Modern technologies for improving elderly patients’ compliance

“…The gold standard of therapy in elderly patients is personally observed or directly observed therapy (DoT) [52]. unfortunately, this is practically unavailable in most cases due to the scarcity of medical and caregiving personnel [53].…”

“…However, in order to utilise their full potential, a certain level of familiarity with programmed products and computer skills, known as digital literacy, is desirable [56]. The widening scope of available technologies include: the monitored use of electronic medication boxes [57], reminders from live operators, automated phone calls, SMS text messages [58], MMS multimedia messages [59], chatbot messages [60], smartphone app reminders [61], realtime video directly observed therapy (vDoT) [52] or recorded video observed therapy (voT) [62] or even ingestible sensors [57]. Besides drug-related interventions, patients' adherence to other prevention and therapy options, like directed physical exercise, may also be supported by means of modern technologies [63], including wearable physical activity trackers [64], accelerometers [65] or pedometers [66].…”

“…video observed therapy, whether in real-time (vDoT) or recorded (voT), can replace directly observed therapy (DoT). Unfortunately, the high demand for personnel and the need for properly operated technical equipment means its use it limited to the few cases where adherence to the therapy regimen is of critical importance and where direct observation by medical personnel is unavailable, as in the case of tuberculosis treatment [52] or buprenorphine [93] or methadone-based take-home opioid dependence treatment programmes [94]. However, recent technological advances mean that photo and video recording and remote transmission with smartphones [95] via telecommunication networks, including the internet, has become inexpensive and easily available to virtually anyone in society, which potentially transforms such therapies into efficient and practical healthcare and public health options [96,97], including in the case of elderly patients with limited selfcare capabilities.…”

“…Modern technologies allowing patients to take drugs under supervision [52,57,62], on prompts from human operators [58] or upon the advice of programmed computer systems [59][60][61] are becoming the new normal. However, with all the networked means of monitoring therapy, a new approach to maximising compliance among patients may be to merge these solutions with various technological means of influence in an attempt to maximise effectiveness through the gamification of therapy, transforming it into a positively engaging contest of sorts, where scores are kept and compared with others, while positive or negative points can be gained for fulfilling therapy-related tasks in a timely manner [103], and task-related and score-related feedback, motivation and incentives can be received [104].…”

Identifying adolescents at risk for suboptimal adherence to tuberculosis treatment: A prospective cohort study

“…A pilot study conducted in Lima demonstrated the acceptability and feasibility of in-person peer support groups and group video-DOT (i.e., multiple adolescents taking their treatment together over a group video call) for adolescents living with HIV [ 31 , 32 ]. Notably, video-DOT for TB treatment is accepted by the WHO and the U.S. Centers for Disease Control and Prevention as a treatment delivery strategy because it achieves treatment outcomes that are at least as effective as conventional DOT, though these effectiveness data come mostly from high-income settings [ 33 , 34 ]. Nonetheless, growing evidence from high TB-burden, resource-limited settings like India also support the acceptability and feasibility of video-DOT [ 35 , 36 ].…”