title: Enhancing management of tuberculosis treatment with video directly observed therapy in New York City.
abstract: METHODS
  Directly observed therapy (DOT), the standard of care for monitoring patients on treatment for tuberculosis (TB), requires substantial health department resources, and can be inconvenient and disruptive for patients.
  
  
  OBJECTIVE
  To determine whether video technology for remote observation of patients on anti-tuberculosis treatment (VDOT) is as effective as in-person DOT.
  
  
  METHODS
  Eligible TB patients in New York City were prospectively enrolled in VDOT from September 2013 to September 2014. We compared treatment outcomes and worker output for VDOT and in-person DOT.
  
  
  RESULTS
  Among 390 patients on DOT for the treatment of TB, 61 (16%) were on VDOT and 329 (84%) on in-person DOT. Adherence to scheduled VDOT sessions was 95% (3292/3455) compared to 91% (32 204/35 442) with in-person DOT (>P < 0.01). VDOT enabled a DOT worker to observe a maximum of 25 patients per day, similar to DOT workers who observed patients in clinic (n = 25), but twice that of DOT workers who observed patients in the community (n = 12). Treatment completion with VDOT was similar to that with in-person DOT (96% vs. 97%, P = 0.63). The primary problems encountered during VDOT sessions were interruption of video and audio connectivity.
  
  
  CONCLUSIONS
  Implementation of VDOT resulted in successful anti-tuberculosis treatment outcomes while maximizing health department resources.
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, New York, USA.
authors.forename: C
authors.initials: C
authors.lastname: Chuck
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, New York, USA.
authors.forename: E
authors.initials: E
authors.lastname: Robinson
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, New York, USA.
authors.forename: M
authors.initials: M
authors.lastname: Macaraig
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, New York, USA.
authors.forename: M
authors.initials: M
authors.lastname: Alexander
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, New York, USA.
authors.forename: J
authors.initials: J
authors.lastname: Burzynski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000008:administration & dosage*; D023801:Directly Observed Therapy / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009519:New York City; D010561:Personnel Staffing and Scheduling; D015397:Program Evaluation; D011446:Prospective Studies; D000068997:Smartphone; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D049269:Videoconferencing / Q000295:instrumentation; D016526:Workload; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents