Evaluation of National Video Directly Observed Therapy Implementation

PROJECT SUMMARYemocha Mobile HealthInc and Johns Hopkins investigators have developed a userfriendlyHIPAA compliant application for asynchronous video directly observed therapyDOTmiDOTThe miDOT platform consists of a patientfacing mobile application where patients can recordvideos of themselves taking medication at their convenience and a providerfacing web portalthat allows providers to monitor adherence and progressvisualize datagenerate reportsviewside effects reportsand automatically send SMS medication remindersThe platformrepresents a patientcentered strategy for improving adherence support and overcomes costand logistical barriers to traditional DOT while maintaining patient autonomy and respectOur SBIR Phase I efforts successfully demonstratedtechnological feasibility of using miDOTfor TB treatment monitoringmiDOT is acceptable and preferred by patients and providers forTB treatment andmiDOT is effective at ensuring high levels of adherence and treatmentcompletionHoweverseveral key knowledge deficits existFirstour Phase I efforts focused onpatients with prior demonstration of good adherence in one stateIt is now imperative todemonstrate that miDOT would be used and effective in a broader patient populationSecondcurrent videoDOT efforts have focused on active TB patientshoweverpublic health authoritieshave also prioritized treatment for the estimatedmillion people in the US living with latent TBinfectionLTBIA short course regimen for LTBI is recommended to prevent progression toactive TBand consists ofmonths of weekly isoniazidINHand rifapentineorHPadministered under DOThoweveruptake has been limited due to this DOT requirementwhichis not logistically feasible with such high patient volumesAlternative selfadministered LTBItreatments can be prescribedbut are lengthymonthsand have poor completion ratesFinallythere is a need to define best practices for miDOT integration and adoption into currentTB programsOur SBIR Phase II goal is to guide programmatic scaleup throughimplementation research while building the necessary technical infrastructure to allow thesystem scale commercially to meet the needs of larger patient populationsPROJECT NARRATIVEThe proposed study will evaluate a nationally representative implementation study on videodirectly observed therapyDOTamong tuberculosisTBpatientsVideo DOT offers the benefitof patient and provider convenience by removing the need for frequentinperson visits and hasthe potential to reduce stigma while improving treatment completion in a more cost effectivemanner than traditional inperson DOTThe proposal will build the technical architecturenecessary to scale the technology in public and private commercial sectors