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      Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial.

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          Abstract

          Directly observed treatment (DOT) has been the standard of care for tuberculosis since the early 1990s, but it is inconvenient for patients and service providers. Video-observed therapy (VOT) has been conditionally recommended by WHO as an alternative to DOT. We tested whether levels of treatment observation were improved with VOT.

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          Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis.

          Payam Nahid, Susan Dorman, Narges Alipanah … (2016)
          The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.
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            Regression standard errors in clustered samples

            W ROGERS, H. Rogers W., WH Rogers … (1993)
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              Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya.

              Jeffrey Hoffman, Janice Cunningham, Andrew J Suleh … (2010)
              Growth in mobile phone penetration has created new opportunities to reach and improve care to underserved, at-risk populations including those with tuberculosis (TB) or HIV/AIDS. This paper summarizes a proof-of-concept pilot designed to provide remote Mobile Direct Observation of Treatment (MDOT) for TB patients. The MDOT model combines Clinic with Community DOT through the use of mobile phone video capture and transmission, alleviating the travel burden for patients and health professionals. Three healthcare professionals along with 13 patients and their treatment supporters were recruited from the Mbagathi District Hospital in Nairobi, Kenya. Treatment supporters were asked to take daily videos of the patient swallowing their medications. Patients submitted the videos for review by the health professionals and were asked to view motivational and educational TB text (SMS) and video health messages. Surveys were conducted at intake, 15 days, and 30 days. Data were collected in 2008 and analyzed in 2009. All three health professionals and 11 patients completed the trial. All agreed that MDOT was a viable option, and eight patients preferred MDOT to clinic DOT or DOT through visiting Community Health Workers. MDOT is technically feasible. Both patients and health professionals appear empowered by the ability to communicate with each other and appear receptive to remote MDOT and health messaging over mobile. Further research should be conducted to evaluate whether MDOT (1) improves medication adherence, (2) is cost effective, and (3) can be used to improve treatment compliance for other diseases such as AIDS. Copyright 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Lancet
                Title: Lancet (London, England)
                Publisher: Elsevier BV
                ISSN (Electronic): 1474-547X
                ISSN (Print): 0140-6736
                Publication date (Electronic): Mar 23 2019
                Volume: 393
                Issue: 10177
                Affiliations
                [1 ] Institute of Health Informatics, University College London, London, UK; Find and Treat, University College Hospitals NHS Foundation Trust, London, UK.
                [2 ] Institute of Health Informatics, University College London, London, UK.
                [3 ] Institute of Health Informatics, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK.
                [4 ] Institute for Global Health, University College London, London, UK.
                [5 ] Centre for Clinical Microbiology, University College London, London, UK.
                [6 ] MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology School of Public Health, Imperial College London, London, UK; NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology School of Public Health, Imperial College London, London, UK; Modelling and Economics Unit, National Infection Service, Public Health England, London, UK.
                [7 ] Research Department of Infection and Population Health, University College London, London, UK.
                [8 ] UCL Respiratory, Division of Medicine, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK.
                [9 ] Division of Global Public Health, School of Medicine, University of California, San Diego, CA, USA.
                [10 ] Institute of Epidemiology and Health Care, University College London, London, UK. Electronic address: a.hayward@ucl.ac.uk.
                Article
                Publisher Item ID: S0140-6736(18)32993-3
                DOI: 10.1016/S0140-6736(18)32993-3
                PMC ID: 6429626
                PubMed ID: 30799062
                SO-VID: 3e001425-c672-4e8b-a50c-3f4248c8ee69
                Copyright © Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
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