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A study in California assessed VDOT for monitoring tuberculosis treatment across 5 health districts to compare adhernece between 174 patients using VDOT an d159 patients using in-person DOT. Results found the median fraction of exposed doses observed among VDOT participants was higher (93.0%,IQR 83.4%-97.1%) than among patients receiving DOT (66.4%, IQR55.1%-89.3%). VDOT cost 32% (range 6%-46%) less than DOT. The study concluded VDOT was considered feasible, acceptable, and achieved high adherence at a lower cost that DOT.
A multicentre, analyst-blindind, randomized controlled study was conducted across 22 clinics in England to test whether levels of treatment observation were improved with VOT. Participants were randomly assigned to either VOT or DOT. The primary outcome was completion of 80% or more scheduled treatment observations over the first 2 months following enrollment. Results showed superiority was determined by a 15% different in proportions of patients with primary outcome (60% vs 75%). The study concluded that VOT is a more effect approach to observation of tuberculosis treatment than DOT. VOT is likely to be preferable to DOT for many patients across a broad range of settings, providing a more acceptable, effective and cheaper option for supervision of daily and multiple daily doses than DOT.
A study conducted in Hanoi, Vietnam across three outpatient tuberculosis clinics aimed to evaluate the feasibility of using asynchronous VDOT to support treatment adherence among patients with bacteriologically confirmed pulmonary tuberculosis. In this cohort study, 40 of 78 eligible participants (51.3%) agreed to commence VDOT. Among participating patients, 27 (71.1%) of patients took all required doses and a median of 88.4% (IQR 75.8%-93.7%) of doses were correctly recorded and uploaded. Participants rated the VDOT interface highly. The study concluded VDOT was feasible and resulted in high rates of treatment adherence in a resource-limited setting.
A pilot cohort study was conducted at a TB clinic in Kampala City, Uganda to evaluate the feasibility of using VDOT for supporting TB treatment adherence. Patients aged 18-65 with >3months remaining of their TB treatment were enrolled and trained to use the VDOT mobile application. The primary outcome was adherence measured as the fraction of expected doses observed. Results found that of the 5150 videos expected, 4231 (82.2%) were received. The median FEDO was 85% (IQR 66%-94%) and 92% of patients reported being very satisfied with using VDOT. The study concluded that VDOT was feasible and acceptable for monitoring and supporting TB treatment, suggesting digital technology holds promise in improving patient monitoring in Uganda.
A study conducted by the New York City Health Department in collaboration with the US CDC enrolled 216 participants in a 2-period crossover, non-inferiority trial with initial randomization to VDOT or in-person DOT across 4 clinics. Participants were asked to complete 20 medication doses using 1 DOT method, then switched methods for another 20 doses. The percentage difference was -2.6% consistent with conclusion of non-inferiority. The study concluded that this trial provides evidence supporting the efficacy of this digital adherence technology, and for the inclusion of electronic DOT in the standard of care.
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