Mobile Phone Video Directly Observed Therapy (VDOT) for Monitoring TB Treatment Adherence (2012-2014)


Funded by Verizon Foundation; PI: Richard S. Garfein, PhD, MPH

In 2010-12, researchers at UC San Diego conducted a pilot study funded by the U.S. National Institutes of Health to evaluate the feasibility and acceptability of a novel, mobile phone-based form of DOT called “Video Directly Observed Therapy” (VDOT) that would overcome many of the barriers to traditional in-person DOT.  In VDOT, patients use mobile phones to record videos of themselves taking their medication, after which the encrypted videos are wirelessly uploaded to a secure server where DOT workers observe them through a password protected website and document each dose taken (more detail available at  The pilot study was conducted in San Diego, CA and Tijuana, Mexico to represent high and low resource settings, and showed that VDOT was highly feasible and acceptable to patients and providers in both cities.  Over 95% of expected medication doses were observed using VDOT.  In addition, most patients (89%) reported never/rarely having problems recording videos, 92% preferred VDOT over in-person DOT, 81% thought VDOT was more confidential, and 100% said they would recommend VDOT to others.  An economic analysis showed that the cost of VDOT was about 1/3 that of in-person DOT in both settings.  Given these results, we received a second grant to upgrade the VDOT application making it cloud-based and more user-friendly, which was evaluated in San Diego, San Francisco, and New York City health departments.

The aims of the scale-up were to:

1. To demonstrate that VDOT is a reliable, secure and safe method of delivering DOT services to multiple TB Control Programs in the U.S.

2. To asses continued feasibility and acceptability of the VDOT system after implementing new features informed by Pilot Study [insert link to GPH VCP-DOT study], and to determine if these findings are replicable in a new site.

The study aims were achieved through:

1. Using VDOT for a group of TB patients in San Diego (n=50), San Francisco (n=50), and New York City (n=50) to determine the feasibility and measure adherence to treatment

2. Interviewing VDOT 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

Site Principal Investigators: Kathleen Moser (San Diego), Julie Higashi (San Francisco), Christine Chuck (New York City)

Collaborators: Kevin Patrick, Timothy Rodwell, Jose-Luis Burgos, Frederic Raab, Phillip Rios, Mark Sullivan, Allison Flick

Project Coordinator: Jazmine Cuevas-Mota

Research Team: Kelly Collins, Fatima Muñoz


1. Dr. Garfein presented “Using Telehealth Technology to Monitor Tuberculosis Treatment Adherence” at the National Consortium of Telehealth Resource Centers, National Telehealth Webinar Series, July 16, 2015.

2. Dr. Garfein presented “Video Directly Observed Therapy (VDOT) for Monitoring Tuberculosis Treatment Adherence” at the American Lung Association of the Southeast, TB/RD Institute, Raleigh, NC, August 11-12, 2015.

3. Dr. Garfein presented “Digital Health and Mobile Medicine - The Real Impact on Care Anywhere” at the Verizon Wireless HealthCare and Life Sciences Summit, Coronado, CA, October 8-9, 2015.

4. Dr. Garfein presented “Thought Leadership” panelist, Verizon Wireless HealthCare and Life Sciences Summit, Coronado, CA, October 8-9, 2015.

5. Dr. Garfein presented “Verizon Partner Success Stories Demonstrations” at the Verizon Wireless HealthCare and Life Sciences Summit, Coronado, CA, October 8-9, 2015.

6. Dr. Garfein presented “Video Directly Observed Therapy (VDOT) to Monitor Tuberculosis Treatment Adherence” at the 2nd International Symposium on Tuberculosis: Clinical, Molecular and Immunological Aspects, Ensenada, BC, Mexico, December 7-9, 2015.

7. Dr. Garfein presented “Recorded Video DOT: A Multi-site California Experience” at the California TB Controllers Meeting, Los Angeles, CA, April 18-20, 2016.

8. M. Gutierrez and L. Ritter presented “Using Video Technologies to Improve Infectious Disease Management: A Case Study of TB & Telehealth” at the American Telemedicine Association Conference, Minneapolis, MN, May 15, 2016.

9. Dr. Garfein presented “Mobile Technology for Monitoring Tuberculosis Treatment Adherence in The US/Mexico Border Region” at the First International Congress on Health Science Research in Mexicali, Mexico, June 9, 2016.

10. Dr. Garfein presented “Six Years of Monitoring TB treatment with Video Directly Observed Therapy (VDOT) in the U.S. and Mexico: How did it Work?” at the 21st Annual Conference of The Union – North American Region. Vancouver, BC, Canada. February 23-25, 2016.

11. Dr. Garfein presented “TB treatment observation using smartphones” at the 47th Union World Conference on Lung Health. Liverpool, England October 28-November 1, 2016.