Mobile Technology Developed at Hopkins Medicine Transforming TB Care in Texas

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Manuank Shah

Harris County Public Health Environmental Services Hailed TB Elimination Champion by CDC

The US Centers for Disease Control and Prevention recently named Harris County Public Health Environmental Services among its 2016 TB Elimination Champions for improving tuberculosis (TB) patient outcomes in the “Maximizing Resources” category. A major component of the agency’s success is the use of miDOT, a smart-phone based technology for Directly Observed Therapy (DOT). miDOT is a technology built on the emocha platform, and both the technology and the platform were developed by researchers at the Johns Hopkins School of Medicine. In 2013, a spin out company, emocha Mobile Health Inc, was formed to take the platform to market. Harris County has licensed miDOT from the start up, and is implementing it in its TB Elimination Program as way to provide a video-based approach to DOT (also referred to as VDOT).   

TB treatment is burdensome, and it requires that health officials witness patients taking their daily medications. miDOT allows patients to record smart-phone videos of themselves taking medication, enter any potential side effects, and then upload the videos to a secure server. A health official then reviews the videos remotely at his or her convenience, eliminating the need for home visits that are costly for the health department and that have the potential to compromise patient privacy.

Developed in 2008 by Dr. Robert Bollinger, Dr. Larry Chang, and Jane McKenzie-White from the Center for Clinical Global Health Education at the Johns Hopkins School of Medicine, and Miquel Sitjar, the emocha mobile platform was originally intended for use with HIV patients in remote areas of Uganda. emocha Mobile Health, Inc., is now an independent, Baltimore-based health technology company.

miDOT was developed by Dr. Maunank Shah of Johns Hopkins, and the technology was initially pilot tested in Baltimore. In addition to Harris County, the technology is being used in research studies in Baltimore City, and Caroline, Anne Arundel, and Montgomery Counties in Maryland as well as in Sydney, Australia. Additional studies in Pune and Bangalore, India, are in the works.

Texas is among the top states for TB disease burden, ranking second nationwide, and the case rate for Harris County (the third most populous US county), is 60% greater than that for the rest of the state. The Harris County Program represents the first large-scale implementation of miDOT for TB elimination by a health department; as of February, 115 patients have been enrolled in the VDOT program using the miDOT platform. In an official statement recognizing Harris County’s efforts, CDC noted that VDOT “enhances patient privacy and autonomy, and augments regimen adherence. VDOT has also reduced health department transportation costs, and improved worker safety.”

“Harris County is making impressive strides in TB control, and we are positively thrilled to see their progress receive recognition, and for miDOT to be playing a big role in that progress,” noted Maunank Shah, MD, PhD, “miDOT has been years in the making, and Harris County’s success in affecting patient outcomes using the technology is the rubber meeting the road for us.”