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Evaluation of National Video Directly Observed Therapy Implementation
emocha Mobile Health, Inc., and Johns Hopkins investigators have developed a user-friendly, HIPAA compliant application for asynchronous video directly observed therapy (DOT) miDOT. The miDOT platform consists of a patient-facing mobile application where patients can record videos of themselves taking medication at their convenience and a provider-facing web portal that allows providers to monitor adherence and progress, visualize data, generate reports, view side effects reports, and automatically send SMS medication reminders. The platform represents a patient-centered strategy for improving adherence support and overcomes cost and logistical barriers to traditional DOT while maintaining patient autonomy an drespect. Our SBIR Phase I efforts successfully demonstrated:
- technological feasibility of using miDOT for TB treatment monitoring
- miDOT is acceptable and preferred by patients and providers for TB treatment, and
- miDOT is effective at ensuring high levels of adherence and treatment completion.
However, several key knowledge deficits exist. First,our Phase I efforts focused on patients with prior demonstration of good adherence in ones tate. It is now imperative to demonstrate that miDOT would be used and effective in a broader patient population.
Second, current video-DOT efforts have focused on active TB patients; however, public health authorities have also prioritized treatment for the estimated 13 million people in the US living with latent TB infection (LTBI). A short course regimen for LTBI is recommended to prevent progress into active TB, and consists of 3months of weekly isoniazid (INH) and rifapentine or 3HP- administered under DOT; however, uptake has been limited due to this DOT requirement, which is not logistically feasible with such high patient volumes. Alternative self-administered LTBI treatments can be prescribed, but are lengthy (4-9months) and have poor completion rates. Finally, there is a need to define best practices from iDOT integration and adoption into current TB programs. Our SBIR Phase II goal is to guide programmatic scale-up through implementation research while building the necessary technical infrastructure to allow the system scale commercially to meet the needs of larger patient populations.
Public Health Relevance
The proposed study will evaluate a nationally representative implementation study on video directly observed therapy (DOT) among tuberculosis (TB) patients. Video DOT offers the benefit of patient and provider convenience by removing the need for frequent, in-person visit sand has the potential to reduce stigma while improving treatment completion in a more cost effective manner than traditional in-person DOT. The proposal will build the technical architecture necessary to scale the technology in public and private commercial sectors.