Each year, the National Tuberculosis Controllers Association brings together public health leaders and partners dedicated to the advancement of TB control and elimination across the United States. This year’s 2019 National TB Conference: Innovate, Implement, Impact focused on a wide array of issues related to tuberculosis prevention and control, including breakout sessions surrounding advocacy strategies, innovations in elimination protocols, and the clinical implications of the disease’s changing landscape.
One recurring theme in eradicating TB has always been rooted in the issue of medication adherence: a critical aspect of effective and curative treatment that also helps to control the spread of the infection and minimizes the development of drug resistance. While video-based medication adherence solutions were featured at last year’s NTCA conference, this year’s poster presentation sessions again reinforced the efficacy of video DOT—coupled with newly developed modalities within the field.
The Maryland Department of Health presented a poster on its effort to effectively expand video Directly Observed Therapy in local health departments across the state. The Maryland Center for Tuberculosis (TB) Control and Prevention explored a long-term and sustainable expansion of video directly observed therapy (DOT) through the use of emocha that ultimately established a more efficient, standardized approach to deliver patient-centric care. The addition of emocha enables state-wide providers to easily leverage technology to support patients throughout the course of their TB treatment. Within three years, thousands of videos were reviewed by LHD staff, and more than 150 patients have utilized the platform for TB treatment monitoring.
The Guam Department of Public Health and Social Services’ poster presentation highlighted its mobile technology innovation through the use of asynchronous video Directly Observed Therapy for patients with tuberculosis. In an attempt to reduce its high tuberculosis (TB) case rates, Guam became the first program in the U.S. Affiliated Pacific Islands to adopt the use of asynchronous video DOT, and provide scalable and patient-centered care to its population. Between August 2018 and January 2019, the implementation of asynchronous video DOT with emocha increased staff capacity to perform DOT under constraints while maintaining high medication adherence and patient satisfaction.The use of emocha’s technology also generated significant cost savings. The program has served as a model for other initiatives in the region, demonstrating that video DOT can potentially help with other conditions on the island.
Harris County Public Health (HCPH) presented two posters on video directly observed therapy. Identifying a need for Texas Health departments to conduct targeted testing in their communities, HCPH recently launched its targeted testing program in an effort to be proactive about TB prevention and elimination. After conducting risk assessments and using Geographic Information Systems (GIS) software, HCPH opted into having targeted testing patients with TB infections placed on video DOT. Given confirmed results surrounding the accessibility and convenience of video DOT, HCPH determined that this modality would allow its clients the flexibility to adhere to their treatment regimen. Ongoing results indicate that the percentage of positive IGRA tests—a blood test to measure TB germs—is close to 10 percent: 3 percent higher than the Oxford Diagnostic Labs national average. 70 percent of those identified as having a latent TB infection are currently on treatment, and being observed using VDOT.
- The Centers for Disease Control electronic DOT (eDOT) study team presented four posters with preliminary data on their ongoing studies to evaluate eDOT, all of which highlighted the benefits of video-based medication adherence solutions. Preliminary findings from these studies indicate that:
- Patients who completed multiple modalities of DOT preferred eDOT.
- eDOT software is user-friendly, as evidenced by the fact that most patients don’t require additional instruction to use the system.
- Asynchronous video DOT results in 10 percent fewer reported issues compared to in-person DOT.
- A majority of doses (77 percent) for patients with rifampin-sensitive TB were observed through eDOT were conducted via asynchronous video, and most of those video visits (56 percent) were completed asynchronously.
These findings reinforce the potential of asynchronous DOT for delivering more timely, convenient, patient-focused care, which aligns with Johns Hopkins’ research findings validating video DOT as a cost-saving, patient-centered component of individualized management plans. As findings demonstrate how asynchronous video DOT can be seamlessly integrated and implemented into this patient population, emocha will continue its goals to enhance patient care, expand access to treatment, and ensure that medication adherence remains a public health priority.