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Smartphone app helps improve tuberculosis treatment

Research in England finds that video-observed therapy intervention has lower dropout rate among patients

Research in England finds that video-observed therapy intervention has lower dropout rate among patients


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Video-observed therapy (VOT) improves adherence to tuberculosis (TB) treatment, has a lower dropout rate and costs less than directly observed treatment (DOT), research has found.

UK TB incidence is high and adherence to treatment is often problematic. DOT is standard, but it is inconvenient for patients and service providers. A randomised controlled trial of 226 patients in 22 clinics in England tested how VOT – using a smartphone app and improved treatment observation – compared to DOT. 

Smartphones and data plans were provided free of charge. The 112 patients in the VOT intervention were trained to record and send videos of every dose ingested seven days per week to a centralised London service. Equal numbers of participants in both groups had a history of homelessness, mental health problems, alcohol or drug misuse or imprisonment. 

Scheduled observations

Significantly more VOT patients (70%) achieved more than 80% of scheduled observations compared to the DOT patients (31%). VOT patients had a lower dropout rate and reported more adverse events (such as vomiting), but this did not result in more unscheduled appointments.

VOT was less costly than DOT even after taking into account phone and data plan costs as it reduced staff time requirements, especially for home-based DOT. VOT is now being used across Find and Treat services in London and other parts of the country.


Reference

Story A, Aldridge RW, Smith CM, et al (2019) Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial. Lancet. 393, 10177, 1216-1224


Vari Drennan is professor of healthcare and policy research at Kingston University and St George’s, University of London

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