S29 A randomised controlled trial comparing smartphone enabled remote video observation with direct observation of treatment for tuberculosis

Background Directly observed treatment (DOT) has been the standard of care for tuberculosis since the early 1990s. In England DOT is targeted at those considered to be at high risk of poor adherence and clinically complex patients. We report the first randomised controlled trial of smartphone-enabled video observation of treatment (VOT) for active tuberculosis compared to DOT. Methods Tuberculosis patients eligible for selective DOT in England were randomised to an offer of asynchronous VOT (daily remote observation using a smartphone app) or DOT (3 or 5 times weekly observation in community or clinic settings). Results 58% of 226 randomised patients had a history of homelessness, drug use, imprisonment, alcohol or mental health problems. Of the 112 patients randomised to an offer of VOT, 70% had over 80% of scheduled observations completed over two months (the primary outcome measure) compared to 31% of 114 patients randomised to an offer of DOT (p Conclusions VOT is a more effective and cheaper approach to observation of tuberculosis treatment than clinic or community based DOT.