Can VOT be a feasible alternative strategy to DOT for treatment of TB?

DOTS (Directly Observed Therapy Short Term) as a strategy (where the patient has to take the TB medication in the presence of a DOTS agent) has been successfully adapted in TB control programs worldwide, including India. Although, it can be administered in home settings as well, there is still some inconvenience involved with DOTS, both to the patient and the healthcare provider, which may affect adherence to treatment.

Video-observed therapy (VOT) has been explored as a possible alternative to DOT. The World Health Organization (WHO) also recommends VOT as an alternative to DOT to improve treatment adherence when the video communication technology is available and can be appropriately organized and operated by health-care providers and patients (WHO Guidelines for treatment of drug-susceptible tuberculosis and patient care 2017 Update).

Results of a multicenter, analyst-blinded, randomized-controlled superiority trial conducted in 22 clinics in England show that VOT was a more effective approach to observation of tuberculosis treatment than DOT

In the trial, 70% patients managed with video observed therapy (VOT; daily observation using a smartphone app) completed >80% of scheduled observations over two months compared to 31% patients who were managed with DOT (observations done 3-5 times per week in the home, community, or clinic settings).

·         VOT allowed higher levels of treatment observation, both over the first 2 months of treatment and throughout treatment vs DOT.

·         VOT also supported daily dosing and was effective for socially complex populations.

·         The drop-out rate was lower with VOT vs DOT.

·         VOT reduced staff time requirements, especially compared with home-based DOT, making VOT cheaper than DOT even after taking into account the costs of the telephones and data plans provided by the study.

These findings suggest VOT as a more acceptable, effective, and cheaper option for supervision of daily and multiple daily doses than DOT.

(Source: Lancet. 2019 Mar 23;393(10177):1216-1224)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA