Video directly observed therapy for supporting and monitoring adherence to tuberculosis treatment in Uganda: a pilot cohort study.

Introduction: Nonadherence to treatment remains an obstacle to tuberculosis (TB) control worldwide. The aim of this study was to evaluate the feasibility of using video directly observed therapy (VDOT) for supporting TB treatment adherence in Uganda.
Methods: From May to December 2018, we conducted a pilot cohort study at a TB clinic in Kampala City. We enrolled patients aged 18-65 years with ≥3 months remaining of their TB treatment. Participants were trained to use a smartphone app to record videos of medication intake and submit them to a secured system. Trained health workers logged into the system to watch the submitted videos. The primary outcome was adherence measured as the fraction of expected doses observed (FEDO). In a secondary analysis, we examined differences in FEDO by sex, age, phone ownership, duration of follow-up, reasons for missed videos and patients' satisfaction at study exit.
Results: Of 52 patients enrolled, 50 were analysed. 28 (56%) were male, the mean age was 31 years (range 19-50 years) and 35 (70%) owned smartphones. Of the 5150 videos expected, 4231 (82.2%) were received. The median FEDO was 85% (interquartile range 66%-94%) and this significantly differed by follow-up duration. Phone malfunction, uncharged battery and VDOT app malfunctions were the commonest reasons for missed videos. 92% of patients reported being very satisfied with using VDOT.
Conclusion: VDOT was feasible and acceptable for monitoring and supporting TB treatment. It resulted in high levels of adherence, suggesting that digital technology holds promise in improving patient monitoring in Uganda.
Competing Interests: Conflict of interest: J.N. Sekandi has nothing to disclose. Conflict of interest: E. Buregyeya has nothing to disclose. Conflict of interest: S. Zalwango has nothing to disclose. Conflict of interest: K.K. Dobbin has nothing to disclose. Conflict of interest: L. Atuyambe has nothing to disclose. Conflict of interest: D. Nakkonde has nothing to disclose. Conflict of interest: J. Turinawe has nothing to disclose. Conflict of interest: E.G. Tucker has nothing to disclose. Conflict of interest: S. Olowookere has nothing to disclose. Conflict of interest: S. Turyahabwe has nothing to disclose. Conflict of interest: R.S. Garfein is a cofounder and the Chief Science Officer of SureAdhere Mobile Technology, Inc.
(Copyright ©ERS 2020.)