JMIR Publications

ABSTRACT

Background:

India accounts for nearly one quarter of the global tuberculosis (TB) burden. Directly observed therapy (DOT), through in-person observation, is recommended in India, though implementation has been heterogenous due largely to resource limitations. Video DOT (vDOT) is a novel, smartphone-based approach which allows for remote treatment monitoring through patient recorded videos. Prior studies in high-income, low disease burden settings, such as the United States, have shown vDOT to be a feasible, though little is known about the role it may play in resource limited, high burden settings.

Objective:

To assess the feasibility and acceptability of vDOT for adherence monitoring within a resource limited, high TB burden setting of India.

Methods:

We conducted a prospective, single-arm, pilot implementation of vDOT in Pune, India. Outcome measures included adherence (proportion of prescribed doses observed by video) and verifiable fraction (proportion of prescribed doses observed by video, or verbally confirmed with the patient following an incomplete/unverifiable video submission). vDOT acceptability among patients was assessed using a post-treatment survey.

Results:

A total of 25 patients were enrolled. The median number of weeks on vDOT was 13 (11-16). Median adherence was 74% (IQR 62-84) and median verifiable fraction was 86% (IQR 74-98). Greater than 90% of patients reported recording and uploading videos without difficulty.

Conclusions:

We have demonstrated that vDOT may be a feasible and acceptable approach to TB treatment monitoring in India. Our work expands the evidence base around vDOT, by being one of the first efforts to evaluate vDOT within a resource limited, high TB burden setting. To our knowledge, this is the first reported use of vDOT in India.