Using Mobile Phones to Monitor Tuberculosis Treatment
Researcher: Richard S. Garfein (UC San Diego), Fatima Munoz
Tuberculosis (TB) is an airborne infectious disease that remains a global health threat affecting over two billion people — one-third of the world’s population — and is one of the three leading causes of death worldwide due to infectious diseases. TB can be effectively treated with antibiotic therapy, but better tools are needed to improve compliance for TB treatment regimens which last for longer than six months, otherwise illness progresses, TB transmission continues and bacteria can become drug-resistant.
To obtain high adherence and prevent drug resistance, health agencies recommend Directly Observed Therapy (DOT) to monitor patients taking each dose of medication; however, DOT is labor and cost intensive, requires transportation, restricts patient mobility, and may not be used when patients live far from health centers.
A solution has been developed by researchers at UC San Diego’s Division of Global Public Health and programmers at Calit2: a monitoring system of Video Directly Observed Therapy (VDOT), which allows patients to use smartphones to make and send videos of each medication dose taken that health workers watch from their office using a secure website. Through this quick, simple process, care providers can focus their efforts on non-adherent patients. In 2010 – 2012, the VDOT System was pilot tested with 43 patients in San Diego and nine patients in Tijuana, which found that VDOT was feasible, acceptable and more than 93 percent of expected doses were observed using VDOT.
PDEL is currently funding work to customize the VDOT software so that it works reliably and securely in the Mexican environment. The team will also establish operational protocols in Spanish and develop data collection instruments needed for a larger pilot study comparing VDOT to traditional in-person DOT among TB patients at the two largest providers of health care for TB cases in Tijuana: the Mexican Institute of Social Security (MISS) and Institute of Health Services, or ISESALUD.
The results of the current work and subsequent pilot study could change policies at IMSS and ISESALUD to allow implementation of VDOT in Baja California and possibly the rest of Mexico.
Increased adherence to TB treatment as a result of VDOT has a significant public health benefits to both Mexico and the United States populations. While TB incidence overall has declined in the U.S., the proportion of foreign-born cases has increased, and 47 percent of all foreign-born cases in San Diego were from Mexico. TB control efforts elsewhere can directly impact TB in the U.S. The U.S.-Mexico border is not a barrier to TB transmission and TB incidence in this region is many times higher than the national averages in Mexico and the U.S.