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. 2021 Aug 1;25(8):655-661.
doi: 10.5588/ijtld.21.0170.

Real-world implementation of video-observed therapy in an urban TB program in the United States

A Perry  1 , A Chitnis  2 , A Chin  2 , C Hoffmann  3 , L Chang  3 , M Robinson  3 , G Maltas  3 , E Munk  3 , M Shah  3
Affiliations

Real-world implementation of video-observed therapy in an urban TB program in the United States

A Perry et al. Int J Tuberc Lung Dis. .

Abstract
in English, French

BACKGROUND: Video directly observed therapy (vDOT) was introduced to increase flexibility and meet patient-specific needs for TB treatment. This study aimed to assess the reach and effectiveness of vDOT for TB treatment under routine conditions in Alameda County, CA, USA, a busy, urban setting, from 2018 to 2020.METHODS: We prospectively evaluated routinely collected data to estimate 1) reach (proportion of patients initiated on vDOT vs. in-person DOT); and 2) effectiveness (proportion of prescribed doses with verified administration by vDOT vs. in-person DOT).RESULTS: Among 163 TB patients, 94 (58%) utilized vDOT during treatment, of whom 54 (57%) received exclusively vDOT. Individuals receiving vDOT were on average younger than those receiving in-person therapy (46 vs. 61 years; P < 0.001). The median time to vDOT initiation was 2.2 weeks (IQR 1.1-10.0); patients were monitored for a median of 27.0 weeks (IQR 24.6-31.9). vDOT led to higher proportions of verified prescribed doses than in-person DOT (68% vs. 54%; P < 0.001). Unobserved self-administration occurred for all patients on weekends based on clinic instructions, but a larger proportion of doses were self-administered during periods of in-person DOT than of vDOT (45% vs. 24%; P < 0.001).CONCLUSION: A TB program successfully maintained vDOT, reaching the majority of patients and achieving greater medication verification than in-person DOT.

CONTEXTE :: Le traitement sous observation vidéo (vDOT) stratégie vDOT a été mise en place afin d’accroître la flexibilité et de satisfaire certains besoins spécifiques des patients dans le cadre du traitement de la TB. Cette étude (2018–2020) avait pour objectif d’évaluer la portée et l’efficacité de la stratégie vDOT dans le traitement de la TB, dans des conditions de routine, en milieu urbain dense dans le Comté d’Alameda (Californie, É tats-Unis).

MÉTHODES :: Nous avons évalué de manière prospective les données recueillies en routine pour estimer 1) la portée (pourcentage de patients mis sous vDOT vs. DOT en personne) ; et 2) l’efficacité (pourcentage de doses prescrites avec administration vDOT vs. DOT en personne).

RÉSULTATS :: Parmi 163 patients atteints de TB, 94 (58%) ont eu recours au vDOT pendant leur traitement, dont 54 (57%) de manière exclusive. Les sujets sous vDOT étaient en moyenne plus jeunes que ceux sous DOT en personne (46 vs. 61 ans ; P < 0,001). Le délai médian avant instauration du vDOT était de 2,2 semaines (IQR 1,1–10,0). Les patients ont été suivis pendant une durée médiane de 27,0 semaines (IQR 24,6–31,9). La stratégie vDOT a permis d’accroître le pourcentage de doses prescrites contrôlées par rapport à la stratégie DOT en personne (68% vs. 54% ; P < 0,001). Une auto-administration non-observée du traitement, avec instructions cliniques, avait été mise en place le weekend pour tous les patients, mais un pourcentage plus important de doses ont été auto-administrées pendant les périodes sous DOTen personne que pendant les périodes sous vDOT (45% vs. 24% ; P < 0,001).

CONCLUSION:: Ce programme de lutte contre la TB a réussi à appliquer la stratégie vDOT sur la durée, parvenant à inclure la majorité des patients et à atteindre des taux de contrôle de traitement plus élevés qu’avec la stratégie DOT en personne.

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Conflict of interest statement

Conflict of interests: MS and LC are among the inventors of the vDOT technology licensed to emocha Mobile Health Inc. Under a license agreement between emocha Mobile Health Inc. and the Johns Hopkins University (JHU; Baltimore, MD, USA), MS, LC, and JHU are entitled to royalties related to technology described in this study. Specific to this study, MS and LC did not and will not receive royalties or compensation from emocha Mobile Health Inc (Baltimore, MD, USA). Also, JHU owns equity in eMocha. This arrangement has been reviewed and approved by JHU in accordance with its conflict of interest policies. As per JHU IRB and Conflicts of Interest office (COI), conflicted study team members (MS, LC) were excluded from accessing the original data set. Oversight of data management, including primary analyses and audit of all data analyses, were done by non-conflicted designees (CH, MR, GM, EM), as approved by the JHU IRB and COI office.

References

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