VCP-DOT: Video Cell Phone - Directly Observed Therapy for Tuberculosis

Funded by NIAID, grant R21- AI088326-0; PI: Richard S. Garfein

Cell Phone

The purpose of this study is to develop and pilot test a novel, cost-effective method of assuring high rates of patient adherence to anti-tuberculosis (TB) medication regimens. An estimated 2.2 billion persons are infected with M. tuberculosis, resulting in 9.2 million cases of disease and nearly 2 million deaths annually. TB is now the leading cause of death among persons with HIV. Reports of drug resistant TB cases – the result of poor adherence to antibiotic treatment – has led to an increasing demand for directly observed therapy (DOT) as a means of assuring high treatment adherence. While daily visits with a healthcare worker to receive DOT places significant costs on patients and providers, the consequences of poor adherence would be far costlier. The goal of our intervention will be to achieve treatment adherence at least as high as traditional DOT at a lower cost and reduced burden to patients and care providers.

The VCP-DOT program is a collaborative effort between the UCSD Division of Global Public Health and the TB Control Programs of San Diego County and the Municipality of Tijuana, BC, Mexico. This pilot study will evaluate the feasibility and acceptability of a novel approach to delivering DOT using cell-phones, through which patients send daily videos of themselves taking their TB medications. Videos are then viewed remotely by a DOT worker located at the TB Control Program office via a web-based video and data management system hosted by CALIT-2 at UCSD. By allowing patients to send videos at any time from any location via their cell phone, we anticipate that patients will miss fewer observed doses because they may take them on a schedule that better suits their lifestyle and travel time is no longer a hindrance to face-to-face DOT. Using VCP-DOT, distance between the patient and their health center will no longer be a limitation of DOT, which would make DOT feasible in some rural areas where it is currently impractical. This study comes at a critical time when drug resistant TB is increasing worldwide and cell phones have for the first time outnumbered landline phones, making interventions such as VCP-DOT both increasingly necessary and feasible.

The primary aims of this pilot study are to:

  • Aim 1: To identify modifiable barriers and facilitators among patients and providers to delivering VCP-DOT.
  • Aim 2: To determine the acceptability and feasibility of VCP-DOT and estimate the level of treatment adherence achieved through this intervention.
  • Aim 3: To characterize the experiences of patients after receiving VCP-DOT and identify components of the program that could be improved to enhance adherence and patient satisfaction.

The study aims will be achieved through:

  1. Conducting focus groups with TB control personnel and patients in San Diego and Tijuana
  2. Using VCP-DOT for a group of TB patients in San Diego (n=40) and Tijuana (n=10) to determine the feasibility and measure adherence to treatment
  3. Interviewing VCP-DOT participants at the beginning and end of treatment to collect information about potential modifiers and mediators of adherence and patient satisfaction to identify correctable problems with the intervention.
  • Principal Investigator: Richard S. Garfein, PhD, MPH
  • Collaborators: Kevin Patrick, Kathy Moser, Paris Cerecer Callu, Maria Gudelia Rangel, Maria L. Zuniga, Jose-Luis Burgos, Timothy C. Rodwell, Frederic Raab, Ganpathy Chockalingam, Mark Sullivan, Allison Flick
  • Project Coordinator: Jazmine Cuevas-Mota
  • Assistant Project Coordinator: Kelly Collins