Tuberculosis (TB) remains one of the deadliest diseases. In 2016, 1.7 million people worldwide died of causes related to TB and 10.4 million people became sick with the disease. In that same year, according to the CDC, the 9,272 cases of TB in the U.S. were the lowest on record. Effective treatment for patients with tuberculosis, which also reduces the spread of the disease, depends on patients taking their medications consistently. Directly observed therapy (DOT) — watching patients take their pills — is a major component of TB control. DOT time and dollar costs measure well against the very real public health threat of untreated patients spreading the dread disease within communities.
The CDC reported that smartphone video surveillance as a DOT component proved highly effective following the natural disaster when Hurricane Harvey hit Texas in summer 2017. The CDC “Notes from the field” detailed the Texas Department of State Health Services (DSHS) TB program’s results. Before the storm, health workers set up 62 TB patients who were going to be in shelters with video-enabled DOT and provided them with ample medication. The patients used Mobile Health Inc.’s emocha, a HIPAA-compliant mobile app. Each day patients used the app to record themselves taking their medication. The software also allowed patients to note side effects. The app transmitted the files including the videos to HIPAA-secure cloud storage via the smartphone where staff monitored the reports. The staff could check in with patients who didn’t send reports and also send encouraging notes.
According to the CDC report, 59 of the patients, or 97%, never missed a medication dose and were monitored successfully with the program. Equally important, while other respiratory illnesses were reported among shelter residents, no suspected cases of undiagnosed TB were detected. Video surveillance has an encouraging potential with DOT as a way to control costs and leverage personnel without compromising care. The CDC’s conclusion from the Hurricane Harvey experience is that video-enabled DOT is appropriate to maintain TB treatment monitoring in circumstances where visits by distributed personnel are not feasible.
