SAN DIEGO Tuberculosis patients now have a less-intrusive treatment program that will improve the likelihood that they will take all their critical medications, thanks to an innovative, locally developed treatment-adherence monitoring system that uses mobile-health technology.
Creation of the new system, Video Directly Observed Therapy (VDOT), was led by Dr. Richard Garfein in collaboration with researchers at the University California, San Diego’s School of Medicine; a team of developers from Qualcomm Institute/Calit2, a research and development unit at the university; and public health officials from San Diego and Tijuana, Mexico. Verizon provided funding via a grant and in-kind technology, including its HIPAA-enabled cloud services and smartphones, to support the expansion of this first-of-its-kind remote treatment monitoring system.
VDOT allows TB patients to video record themselves taking their daily medications on smartphones and send the videos to health departments, which then can remotely monitor and document each dose of medication. Because poor compliance with TB treatment regimens leads to ongoing disease, acquisition of drug resistant forms of TB, and transmission of TB to community members, health departments in the U.S. spend millions of dollars driving to patients’ homes every day to watch them take their pills. This often stigmatizes patients, limits their mobility and imposes a financial burden on health departments. VDOT provides the same level of adherence monitoring at a fraction of the cost, and with much greater acceptability to patients than in-person observation.
Last year, a National Institutes of Health-funded pilot of VDOT in San Diego and Tijuana found that nearly all (more than 93 percent) of prescribed doses were observed using videos made and sent by the patients, and 100 percent of the patients said they would recommend VDOT to other TB patients. Additionally, the program significantly reduced the transportation and staffing costs for the San Diego and Tijuana health departments. Patients appreciated the mobility that VDOT allowed and the convenience of taking medications on their own schedules.
“MHealth applications like VDOT can be game-changers when it comes to accelerating the pace of TB control and eradication,” said Dr. Garfein. “VDOT significantly reduces the cost and personnel burden of monitoring patient-treatment adherence, allowing healthcare providers to concentrate their limited resources on the patients with the greatest adherence needs.”
The San Diego County TB Control Program is already using VDOT for TB patients’ treatment, and health departments in San Francisco and New York City will soon begin using the new system. Other local, state and federal public health agencies, including the Centers for Disease Control and Prevention, and public health agencies abroad have shown interest in VDOT.
(NOTE: A demonstration of the VDOT system can be viewed via live video stream on Aug. 15 at 11 am. PT; to access, click calit2.net)
VDOT Addresses a Life-threatening Infectious Disease
Tuberculosis is the second-leading cause of infectious disease deaths worldwide and kills more than 1.4 million people every year. This disease is curable if patients strictly follow an appropriate antibiotic regimen, which typically requires taking a combination of pills daily for six months. However, inappropriate treatment regimens and poor medication adherence have led to the emergence of drug-resistant strains of the bacterium. As a result, TB, which had been curable for decades, is once again becoming incurable. In 2009, several countries recorded cases of TB that were resistant to all active anti-TB medications.
In San Diego County, it costs about $27,000 to treat one drug-susceptible case of TB and about $130,000 for a case of multidrug resistant TB.
Verizon Partnership Provides Secure Cloud Services, Smartphones
Verizon partnered with UC San Diego to support a national scaling of its VDOT treatment-adherence system. Verizon provided funding and technology for the university to scale up its prototype VDOT app, which was designed to serve single health departments. The upgraded version, VDOT 2.0, uses Verizon’s HIPAA-enabled cloud solution and makes it possible for multiple health departments to use VDOT simultaneously to monitor TB treatment for thousands of patients. Each participating health department will be able to securely store patients’ health information and medication records that are only accessible to the departments’ own staff. In addition, the Verizon’s HIPAA-enabled cloud gives health departments their first centralized platform to securely exchange information and communicate with their patients.
Verizon will also initially provide 300 smartphones that will be distributed to patients at the first three VDOT 2.0 launch sites. The in-kind smartphone donations to the public health departments will help seed the use of VDOT and assist them in demonstrating the efficacy of mHealth solutions like VDOT to improve adherence and lower cost.
Anthony Llompart, Verizon Foundation director of healthcare programs, said: “Our collaboration with Dr. Garfein demonstrates the power of public and private partnerships to scale innovation to improve health outcomes for those who need it most. The VDOT program leverages technology to enable improved access and quality of healthcare, making UC San Diego an ideal partner for Verizon’s Innovative Healthcare Initiative.”
Verizon’s Innovative Healthcare Initiative supports technology-enabled patient care programs designed to improve quality and access to care for underserved communities. Health departments that are interested in VDOT can contact Debra Kain for more information at 619-543-6163 or ddkain[.]ucsd.edu.
About the University of California, San Diego
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