Smartphone App Offers Alternative Treatment Monitoring for Tuberculosis Patients

Tuberculosis patients normally require daily in-person visits with a health care worker, but now, preliminary findings from a recent study indicate that a video-based application for smartphones may be an effective and less costly approach to daily care.

Tuberculosis (TB) is one of the top 10 causes of death worldwide. According to the World Health Organization (WHO), there were 10.4 million new individuals with TB illness and 1.7 million TB deaths in 2016, heavily impacting certain countries in Asia and Africa. The infectious disease, caused by Mycobacterium tuberculosis bacteria, can result in potentially serious lung infections as well as infections in the kidney, brain, and spine. Individuals who are infected with TB but don’t become sick have a condition called latent TB and need to be treated with medication to stop the bacteria from becoming active. Treating for TB disease can take more than 9 months and requires patients to complete a rigorous course of antibiotic medications.

TB patients who don’t complete their treatment course or skip doses of medicine can fall ill again and the bacteria can become drug-resistant. Multidrug-resistant, extensively drug-resistant, and totally drug-resistant forms of TB that fail to respond to some or all of the anti-TB drugs have become a growing public health problem, preventing global goals to stop TB. Poor treatment adherence is fueling the problem, but in a new study published in the journal Open Forum Infectious Diseases, researchers from the Johns Hopkins School of Medicine say that a smartphone video application may serve as a new tool for the measurement of TB treatment adherence.

The new app investigated in the study is designed to provide video Directly Observed Therapy (DOT), a strategy in which health care workers, volunteers, or family members help TB patients adhere to their daily antibiotic treatment regimens. TB treatment often also includes recommendations for patient isolation in the home or hospital to prevent the spread of the disease. While the medication and additional measures can effectively work to treat TB, in-person DOT visits can be expensive and difficult for patients to schedule. As a result, poor treatment adherence can occur, leading to relapse.

In the new study, the research team tested a video DOT application on 28 adult TB patients being treated by 3 Maryland health departments. The video smartphone application allowed patients to have their therapy monitored in place of in-person visits. Patient adherence to treatment regimen was 94% for the video DOT patients, comparable to the 98% rate of adherence for the in-person control group. In addition, video DOT had a cost savings of $1,391 per patient over a standard 6-month course of treatment. All patients reported the video application as ‘easy to use’ and preferred it over in-person DOT visits. The study’s limitations included a small sample size and non-randomization, so the researchers emphasize that while video DOT may be a promising approach to treatment, it may not work for all patients.

“We believe video DOT offers an alternative that appears to be as effective as in-person daily visits by health care workers to assure compliance with drug treatment but also empowers patients to manage their TB without added stress,” said the study’s first author, Samuel Holzman, MD, in a recent statement.