Video Directly Observed Therapy: Practice to Policy Project (P3)


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

Research Partner: Center for Connected Health Policy – Mario Gutierrez, Lois Ritter, Mei Kwong

The purpose of this study was to inform health policy and develop best practices for expanding mHealth in California.  Through a collaboration with the Center for Connected Health Policy (CCHP), California Department of Public Health (CDPH), and five County Health Departments in California, the study evaluated treatment adherence, patient perceptions and costs of asynchronous Video Directly Observed Therapy (VDOT) to traditional in-person Directly Observed Therapy (DOT). 

The study objectives were to:

1. To determine whether VDOT is as reliable as in-person DOT for ensuring that TB patients ingest their medications.

2. To demonstrate that VDOT can be applied in both low-burden rural and high-burden urban counties in California.

3. To estimate patient and provider costs associated with VDOT.

4. To develop Best Practices Guidelines for the use of VDOT throughout California.

The study objectives were achieved through a two-year (2014-2016) study of VDOT in urban and rural counties in California.  Data from three high-burden sites that have used VDOT (i.e., San Diego, San Francisco, and Santa Clara Counties) and two new low-burden sites that have never used VDOT (e.g., Imperial and San Joaquin Counties) were used to assess the study aims. For all 5 sites, newly diagnosed patients with active TB or suspected TB disease and meeting the study criteria were sequentially invited to participate. Participants were interviewed before and after using VDOT to assess sociodemographics, behavioral risk factors, comfort using smartphone features and perceptions of VDOT. All participants received in-person DOT for at least 2 weeks prior to initiating VDOT. Medication observation rates were calculated for the period between the start and end of VDOT use. To obtain comparison data for in-person DOT, medical records were reviewed from a sample of patients who had received anti-TB therapy by DOT at the 5 participating sites. Results of the study have been submitted for publication.

Principal Investigator: Richard S. Garfein, PhD, MPH

Site Principal Investigators: Kathleen Moser (San Diego), Julie Higashi (San Francisco), Julie Vaishampayan (San Joaquin), Paula Kriner (Imperial), Teeb Al-Samarrai (Santa Clara)

Collaborators: Rocio Agraz-Lara, Teresa Ampie, Anne Cass, Donald Catanzaro, Janette Dubski, Jennifer Flood, Mario Gutierrez, Cynthia Haines, Pamela Kennedy, Mei Kwong, Stephanie Le, Krystal Liang, Lin Liu, Laura Nasseri, Floreida Quiaoit, Lois Ritter, Laura Romo, Jaspreet Sidhu, Stephanie Spencer, Janice Westenhouse, Jan Young, and Miguel Zamora.

Study Coordinator: Jazmine Cuevas-Mota

Study Team: Fatima Muñoz, Kelly Collins, Michelle Bulterys, Fred Raab, Phil Rios

Funder (California HealthCare Foundation): Margaret Laws, Jared Teo


1. Dr. Garfein presented “Best Practices Guidelines for Using Mobile Technology to Monitor Tuberculosis Treatment Adherence in California” at the California Tuberculosis Controllers Association Meeting, Sacramento, CA, April 20-21, 2015.

2. 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.

3. 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.

4. 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.

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

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

7. 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.

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

9. 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.

10. 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.

11. 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.

12. Dr. Garfein presented “VDOT Practice to Policy Project (P3): Preliminary Findings and Feedback” at a Webinar for VDOT P3 Study sites, San Diego, CA, July 29, 2016. 

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


1. California Department of Public Health and California Tuberculosis Controllers Association, Joint Guidelines “Guidelines for Electronic Directly Observed Therapy (eDOT) Program Protocols in California, published August 2016.