JMIR Publications

ABSTRACT

Background:

Tuberculosis treatment requires at least six months of antibiotics for drug sensitive cases, and longer for drug resistance. In the directly observed therapy (DOT) strategy for insuring patient compliance the patient is directly observed taking their medication, usually at daily visits to a health post, that the patients often find daily visits onerous and disruptive. An alternative is video directly observed therapy (VDOT), in which the patient records themselves taking the medication, and the video is uploaded and reviewed by a health worker. We developed a comprehensive tuberculosis (TB) management software system using VDOT that is installed on the smartphones of patients and health workers. It was implemented into the routine TB control program of the Nanshan District of Shenzhen, China.

Objective:

The study aimed to compare the performance of the VDOT-based system with a retrospective analysis of results with DOT based therapy over the prior 20 months.

Methods:

Patients beginning treatment between September 2017 and August 2018 were enrolled into the VDOT group, which was compared to retrospective data collected on patients who began TB treatment between January 2016 and August 2017 and were managed with routine DOT. Sociodemographic characteristics, clinical features, understanding of the illness, treatment adherence, time and costs for medication, sputum smear positivity and satisfaction etc. were compared between the two groups. Attitudes toward the management model and the system among medical workers were analysed.

Results:

On analyzing the results from the 158 patients of the DOT group and 235 patients of the VDOT group, The VDOT group had significantly higher Fraction of Doses Observed (FDO) (P＜0.001), less missed observed doses (P＜0.001) and treatment discontinuations (P＜0.05). over 79.1% of VDOT patients had > 85% of their doses observed, while in contrast, 80% of the DOT patients had < 85% of their doses observed. All patients were cured without recurrences. The VDOT management required significantly (P＜0.001) less median time (300 min.) and transportation costs (¥53) for the patients than DOT did (1240 min. and ¥276). Significant more patients (191/220, 81.3%) in the VDOT group preferred the prescribed model compared to those (37/125, 28.2%) with DOT (P＜0.001). And the overwhlelming majority of the medical workers (61/66, 92.4%) thought that the VDOT model was more convenient for managing TB patients.

Conclusions:

Implementation of a VDOT-based system into the routine program of TB management significantly increased patient adherence to their drug regimens, was less expensive and required less time from patients. It was easy to implement and achieved high levels of satisfaction in both patients and medical workers. Comprehensive VDOT-based TB management represents a viable and improved evolution of DOT. Implementation of such a system can be expected to achieve better results than can be obtained with DOT in routine TB management. Clinical Trial: No.