A study at the Johns Hopkins University showed that a video-based app may be less costly and improve privacy concerns for tuberculosis patients compared to in-person hospital visits to seek tuberculosis treatment known as directly observed therapy (DOT).

“We believe video DOT offers an alternative that appears to be as effective as an in-person daily visits by health care workers to assure compliance with drug treatment, but also empowers patients to manage their TB without added stress,” says Samuel Holzman, M.D., a research fellow in the department of infectious diseases at the Johns Hopkins University School of Medicine.

Tuberculosis is typically treated for six months with a battery of daily antibiotics that include a multidrug combination that can be challenging patients to take. The number of side-effects related to the drugs and the motivation needed to continue the long treatment courses can cause patients to stop their treatment early without appropriate monitoring and strong support. Treatments become even more intensive when caring for multidrug or extensively drug-resistant TB.

Most local health departments in the U.S. require health care workers to observe patients taking their medications to make sure they were taken correctly and monitor for side-effects. In most cases, in-person DOT is conducted five days a week on weekdays and is costly.

“In an era when we are focused on patient centered care, having to meet a health provider every single day is logistically challenging and can be personally invasive,” says Maunank Shah, M.D., Associate Professor of Medicine in the Department of Infectious Diseases at the Johns Hopkins University School of Medicine.

Researchers tested out video DOT by conducting a study using the smartphone app developed by emocha Mobile Health and clinician-scientists at the Johns Hopkins University School of Medicine.

28 adult TB patients being treated at three health departments in Maryland participated in the pilot study.

The results for patient adherence to treatment was approximately the same between the video DOT and in-person DOT, 94 percent and 98 percent respectively. Researchers found that the overall proportion of prescribed doses that were verified through observation was 6 percent higher with video DOT compared to in-person DOT.

All of the patients felt that the emocha platform was ‘easy to use’ and preferred it over in-person DOT.

Video DOT costs $674 on average per patient, compared with $2,065 for in-person DOT of weekly in-person visits. The researchers estimated the range of costs to implement video DOT at health departments could range from $66 to $1,449 per patient for a standard six month treatment course.

Overall, the investigators found that ninety percent of traditional in-person DOT costs are spent on health worker services.

The video DOT costs were mostly in the software, phones and their data plans, with labor accounting for only 20 percent of the cost. In this study, 25 patients (89 percent) elected to use their own devices, leading to additional health department cost savings.

Researchers found that video DOT provides a patient-centered approach to TB treatment monitoring that offers patients more flexibility and privacy, while allowing health departments the ability to document and support treatment adherence.

Researchers believe video DOT to be a promising technology for helping TB programs around the world manage TB.

Because the app allows patients to record their doses without a health worker present, the app could enable more medication observation, such as on weekends.

MiDOT is one of three video-based technologies that allows for asynchronous recording of patients taking prescribed antibiotic doses. Others include Aricure that uses artificial intelligence to monitor patients, and SureAdhere.