Asynchronous Video Directly Observed Therapy to Monitor Short-Course Latent Tuberculosis Infection Treatment: Results of a Randomized Controlled Trial

Authors

• Richard S. Garfein, University of California, San Diego
• Lin Liu, University of California, San Diego
• Javier Cepeda, Johns Hopkins Bloomberg School of Public Health, Baltimore
• Susannah Graves, San Diego County Health and Human Services Agency, San Diego, California
• Stacie San Miguel, University of California, San Diego
• Antonette Antonio, San Diego County Health and Human Services Agency, San Diego, California
• Jazmine Cuevas-Mota, University of California, San Diego
• Valerie Mercer, University of California, San Diego
• McKayla Miller, University of California, San Diego
• Donald G. Cantazaro, University of Arkansas, Fayetteville
• Phillip Rios, University of California, San Diego
• Fredric Raab, University of California, San Diego
• Constance A. Benson, University of California, San Diego

Document Type

Article

Publication Date

4-2024

Keywords

adherence, clinical trial, latent tuberculosis infection (LTBI), mHealth, video directly observed therapy (VDOT)

Abstract

Background

Observing medication ingestion through self-recorded videos (video directly observed therapy [VDOT]) has been shown to be a cost-effective alternative to in-person directly observed therapy (DOT) for monitoring adherence to treatment for tuberculosis disease. VDOT could be a useful tool to monitor short-course latent tuberculosis infection (LTBI) treatment.

Methods

We conducted a prospective randomized controlled trial comparing VDOT (intervention) and clinic-based DOT (control) among patients newly diagnosed with LTBI who agreed to a once-weekly 3-month treatment regimen of isoniazid and rifapentine. Study outcomes were treatment completion and patient satisfaction. We also assessed costs. Pre- and posttreatment interviews were conducted.

Results

Between March 2016 and December 2019, 130 participants were assigned to VDOT (n = 68) or DOT (n = 62). Treatment completion (73.5% vs 69.4%, P = .70) and satisfaction with treatment monitoring (92.1% vs 86.7%, P = .39) were slightly higher in the intervention group than the control group, but neither was statistically significant. VDOT cost less per patient (median, $230; range, $182−$393) vs DOT (median, $312; range, $246−$592) if participants used their own smartphone.

Conclusions

While both groups reported high treatment satisfaction, VDOT was not associated with higher LTBI treatment completion. However, VDOT cost less than DOT. Volunteer bias might have reduced the observed effect since patients opposed to any treatment monitoring could have opted for alternative unobserved regimens. Given similar outcomes and lower cost, VDOT may be useful for treatment monitoring when in-person observation is prohibited or unavailable (eg, during a respiratory disease outbreak). The trial was registered at the National Institutes of Health (ClinicalTrials.gov NTC02641106).

Citation

Richard S Garfein, Lin Liu, Javier Cepeda, Susannah Graves, Stacie San Miguel, Antonette Antonio, Jazmine Cuevas-Mota, Valerie Mercer, McKayla Miller, Donald G Catanzaro, Phillip Rios, Fredric Raab, Constance A Benson, Asynchronous Video Directly Observed Therapy to Monitor Short-Course Latent Tuberculosis Infection Treatment: Results of a Randomized Controlled Trial, Open Forum Infectious Diseases, Volume 11, Issue 4, April 2024, ofae180, https://doi.org/10.1093/ofid/ofae180

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.