Tuberculosis Treatment Monitoring by Video Directly Observed Therapy in 5 Health Districts, California, USA

Abstract

We assessed video directly observed therapy (VDOT) for monitoring tuberculosis treatment in 5 health districts in California, USA, to compare adherence between 174 patients using VDOT and 159 patients using in-person directly observed therapy (DOT). Multivariable linear regression analyses identified participant-reported sociodemographics, risk behaviors, and treatment experience associated with adherence. Median participant age was 44 (range 18-87) years; 61% of participants were male. Median fraction of expected doses observed (FEDO) among VDOT participants was higher (93.0% [interquartile range (IQR) 83.4%-97.1%]) than among patients receiving DOT (66.4% [IQR 55.1%-89.3%]). Most participants (96%) would recommend VDOT to others; 90% preferred VDOT over DOT. Lower FEDO was independently associated with US or Mexico birth, shorter VDOT duration, finding VDOT difficult, frequently taking medications while away from home, and having video-recording problems (p<0.05). VDOT cost 32% (range 6%-46%) less than DOT. VDOT was feasible, acceptable, and achieved high adherence at lower cost than DOT.

Keywords: California; United States; VDOT; antimicrobial resistance; bacteria; mHealth; medication adherence monitoring; patient-centered care; smartphone; tuberculosis and other mycobacteria; video directly observed therapy; video technology.

Figure 1

Schematic of asynchronous VDOT in a study assessing VDOT for monitoring tuberculosis treatment, 5 California health districts, 2015–2016. Patients use VDOT smartphone application to record a video of themselves ingesting their medications. After recording stops, the application encrypts the video and transfers it through a cellular or Wi-Fi connection to a server for storage and playback. On a routine basis, treatment monitors log into a secure website to view each video and document their observations. Missing videos or videos not showing complete dose ingestion trigger follow-up procedures to investigate missed doses and provide patient support as needed. VDOT, video directly observed therapy.

Figure 2

FEDO among patients monitored ingesting medication for tuberculosis by VDOT compared with FEDO and adherence for patients monitored using in-person DOT in a study assessing VDOT for monitoring tuberculosis treatment, 5 California health districts, 2015–2016. FEDO assessed by number of complete doses observed through VDOT divided by the number of doses expected. Adherence assessed by number of doses observed through DOT divided by the number of prescribed doses. Because missed or self-administered doses had to be rescheduled, the number of times a dose was expected could exceed the number of doses prescribed. DOT, directly observed therapy; FEDO, fraction of expected doses observed; VDOT, video directly observed therapy.