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. 2022 Oct 26;22(1):800.
doi: 10.1186/s12879-022-07787-4.

Tuberculosis treatment adherence in the era of COVID-19

Christopher K Lippincott  1 , Allison Perry  2 , Elizabeth Munk  1 , Gina Maltas  1 , Maunank Shah  3
Affiliations

Tuberculosis treatment adherence in the era of COVID-19

Christopher K Lippincott et al. BMC Infect Dis. .

Abstract

Background: In-person directly observed therapy (DOT) is commonly used for tuberculosis (TB) treatment monitoring in the US, with increasing usage of video-DOT (vDOT). We evaluated the impact of COVID-19 on TB treatment adherence, and utilization and effectiveness of vDOT.

Methods: We abstracted routinely collected data on individuals treated for TB disease in Baltimore, Maryland between April 2019 and April 2021. Our primary outcomes were to assess vDOT utilization and treatment adherence, defined as the proportion of prescribed doses (7 days/week) verified by observation (in-person versus video-DOT), comparing individuals in the pre-COVID and COVID (April 2020) periods.

Results: Among 52 individuals with TB disease, 24 (46%) received treatment during the COVID-19 pandemic. vDOT utilization significantly increased in the COVID period (18/24[75%]) compared to pre-COVID (12/28[43%], p = 0.02). Overall, median verified adherence was similar pre-COVID and COVID periods (65% versus 68%, respectively, p = 0.96). Adherence was significantly higher overall when using vDOT (median 86% [IQR 70-98%]) compared to DOT (median 59% [IQR 55-64%], p < 0.01); this improved adherence with vDOT was evident in both the pre-COVID (median 98% vs. 58%, p < 0.01) and COVID period (median 80% vs. 62%, p = 0.01).

Conclusion: vDOT utilization increased during the COVID period and was more effective than in-person DOT at verifying ingestion of prescribed treatment.

Keywords: Medication adherence; Telemedicine; Tuberculosis; Video DOT; mHealth.

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Conflict of interest statement

MS 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 and JHU are entitled to royalties related to technology described in this study. Specific to this study, MS 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) 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 (GM, EM, CL), as approved by the JHU IRB and COI office. AP, GM, EM and CL do not have any conflict of interest.

Update of

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