Recommendations for the Use of Video Direct Observation Therapy During Tuberculosis Treatment — United States, 2023


Truong CB, Tanni KA, Qian J.* Systematic review and meta-analysis Setting up tuberculosis programs in Australia, China, Moldova, UK and US Synchronous or asynchronous vDOT compared to community or clinic-based face-to-face DOT Patients with TB or LTBI who have been treated for 4-9 months Compliance Patient took at least 80% of prescribed dose Patients with vDOT 360/457 (78.8%):
Patients with in-person DOT 106/390 (27.2%) RR (95% CI) = 2.79 (2.26 to 3.45) Better results with vDOT compared to face-to-face DOT treatment completed Patients did not prematurely discontinue treatment or miss follow-up Patients with vDOT 124/157 (79.0%).
Patients with in-person DOT 436/639 (68.2%) RR (95% CI) = 1.33 (0.73 to 2.43) vDOT and face-to-face DOT are equivalent microbiological solution – Radiographs and negative sputum smears in the last month of treatment and ≥1 prior occasion of patients with positive sputum smears at the start of treatment Patients with vDOT 304/327 (93.0%).
Patients with face-to-face DOT 289/329 (87.8%) RR (95% CI) = 1.06 (1.01 to 1.11) Better results with vDOT compared to face-to-face DOT Perry A, Titonis A, Ching A, et al. Prospective observational study Urban Tuberculosis Program, Alameda County Public Health Department, California Asynchronous vDOT compared to community-based face-to-face DOT Number of people receiving tuberculosis treatment in 2018-2020 Compliance Percentage of Total Prescription Amount Validated by Weekend and Holiday Self-Administration Observation§ 68.4% of the vDOT dose.
53.9% of face-to-face DOT dose p<0.001 Better results with vDOT compared to face-to-face DOT treatment completed Treatment completion and success was based on intake of the set target dose 96% of vDOT patients.
90% of in-person DOT patients p = 0.326 vDOT and face-to-face DOT are equivalent microbiological solution Mean days to culture conversion in patients with positive sputum smears at the start of treatment vDOT 48 days;
Face-to-face DOT 47 days p = 0.843 vDOT and face-to-face DOT are equivalent Virginski J, Manganese JM, Ram CK, etc. Randomized controlled trial Urban Tuberculosis Program at 4 Clinics, NYC DOHMH, New York Synchronous and asynchronous vDOT compared to community and clinic-based face-to-face DOT 173 patients with an 8-week crossover period Compliance Percentage of dosage observed to be taken completely by participants 89.8% of the vDOT dose.
87.2% of face-to-face DOT dose** percent difference†† (95% CI) = -2.6% (-4.8% to -0.3%) vDOT and in-person DOT are comparable (trials used non-inferiority design)



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