Abstract
In Thailand, directly observed therapy (DOT) has been performed for tuberculosis treatment monitoring for two decades. However, this program lacks an accountability system leading to becoming an unsustainable strategy, especially to continue DOT during the pandemic of COVID-19. The research team developed a video observed therapy (VOT) system using the mobile application called "TH VOT" to monitor medication adherence among tuberculosis patients. The system provided feasibility and safety to both the patients and their observers. The observers can remotely inspect the patient’s taking medication through the videos sent by the patients. The system was implemented in Hat Yai and Mueang Songkhla District, Songkhla province, Southern Thailand, and assessed its usability by the participants in these jurisdictions. All of the users could use the system to perform the VOT sessions, and they rated the system above-average level of the general benchmark of UEQ for its usability. A cluster randomized controlled trial of patients with pulmonary TB and their observers was conducted over a 60-day period to compare the cumulative compliance days, smear conversion rate, and the number of adverse events reported in the VOT system with those in the traditional DOT system. The study recruited 63 patients for the VOT program and 65 patients for the DOT program. Patients in the VOT program had an average of 27.6 cumulative compliance days, while those in DOT had 12.4 on average. The mean difference was 15.2 (95% confidence interval [CI]; 0.6 to 29.7). Observers in the VOT program averaged 21.5 cumulative compliance days, while those in DOT observed 0.3 days on average. The mean difference was 21.2 (95% CI; 10.8 to 31.6). There is no significant difference in the smear conversion rate, and the number of adverse events reported. In conclusion, TH VOT significantly outperformed the traditional DOT in ensuring compliance with TB treatment for both patients and observers. However, the low compliance rates observed in both groups suggest a need for system improvements and regulatory policies to ensure accountability of the observers.
