Covid-19: Is Mobile Health Tuberculosis Treatment Care by Video Directly Observed Therapy (vDOT) an acceptable alternative in COVID-19 Pandemic? A Study in Suburban Mumbai India - a Low Middle Income Country.
1. *Dr Jahoorahmad Z Patankar MS MRCSEd
2. **Dr Vinita Gaikwad PhD (Information Technology) MCM
*Research Committee Member: Thakur Institute of Management Studies, Career Development & Research (TIMSCDR).
**Director: Thakur Institute of Management Studies, Career Development & Research (TIMSCDR).
BACKGROUND: India accounts for nearly one-quarter of the global tuberculosis (TB) burden. Directly observed treatment (DOT) through in-person observation is recommended in India, although implementation has been heterogeneous due largely to resource limitations.
Although directly observed therapy (DOT), is considered the preferred method for adherence monitoring by health agencies including the World Helath organization (1), varying degrees of effectiveness have been reported from delivery of DOT through home visits by DOT workers, patient visiting clinics, and trusted family or community members performing observations (2). Furthermore the DOT process itself can hinder treatment because of its high cost personnel requirements, potential for stigma, impact on patient income and mobility, and travel required by patients or healthcare workers (3).
INTRODUCTION: It is important that the progress made in TB prevention and care is not reversed by the COVID19 pandemic.
Given the levels of disruption in TB services being observed in multiple countries – then we could expect a 13% increase in TB deaths, bringing us back to the levels of TB mortality that we had 5 years ago. https://www.who.int/docs/default-source/documents/tuberculosis/infonote-tb-covid-19.pdf . Healthcare providers typically rely on in-person meetings to make sure patients are taking their prescribed medications (directly observed therapy, of DOT).
Adherence to tuberculosis (TB) treatment is important for promoting individual and public health.
With COVID-19 LOCKDOWN likely to be prolonged and protracted in Mumbai city and the post-corona new normal, public health programs or community clinics serving disadvantaged populations, that regimen is difficult to uphold – meetings are skipped or missed, medications aren’t taken, and the patient’s health doesn’t improve or deteriorates, leading to increased treatment costs.
Two Immediate questions come to mind:
1. How can we protect people seeking TB care during the COVID-19 PANDEMIC?
2. Importantly what measures should be in place to protect staff working in TB laboratories and health care facilities, and community health workers from COVID-L19 Infection.
HYPOTHESIS: Video directly observed therapy (VDOT), mHealth platform in which patients use an app to record themselves taking medications, can improve adherence and reduce costs, in a COVID-19 pandemic in adherence to DOT Tuberculosis Treatment in “red zone contamination” areas of a highly dense populated suburb of Mumbai city
OBJECTIVES: With mHealth app that allows a patient to use a smartphone to record himself or herself taking a prescribed medication at a specific time, providers can better track and manage medication adherence regardless of where provider and patient are located. One provider can also keep track of a larger group of patients.
GOALS OF STUDY: The goal of the study was to assess the feasibility and acceptability of mobile phone supported vDOT for adherence monitoring within a covid-19 pandemic affected limited-resource, high TB burden setting of high density inhabited suburban district of Mumbai, Maharashtra state, India.
METHODS: The project would be conducted by Thakur institute of Management Studies, Career Development & Research (TIMSCDR) and nearby Public Primary-Level Health Care facilities. It would include involving faculty members for research study and software support of computing requirements.
Methodology: Conduct a prospective, single-arm, pilot implementation of vDOT at nearby Public Primary-Level Health Care facility in suburban Mumbai, Maharsthra State, India. Outcome of measures included adherence (proportion of doses observed by smart phone video) and verifiable fraction (proportion of prescribed doses observed by video or verbally confirmed with patient following an incomplete/unverifiable video submission). vDOT acceptability amongst patients was assessed during a post-treatment survey.
CONCLUSION: The use of digital health technologies should be intensified to support patients and programs proved communication, counseling, care, and information management, among other benefits. In line with WHO recommendations, technologies like electronic medication monitors and video-supported therapy can help patients complete their TB treatment.
Keywords: mHealth, medication adherence monitoring, smartphone, video technology, tuberculosis, video directly observed therapy, VDOT.
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