Lam Chee Kin, McGinnis Pilote Kara, Haque Ashraful, Burzynski Joseph, Chuck Christine, Macaraig Michelle
Centers for Disease Control and Prevention, Atlanta, GA, United States.
Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States.
J Med Internet Res. 2018 Nov 20;20(11):e287. doi: 10.2196/jmir.9825.
Since January 2013, the New York City (NYC) Health Department Tuberculosis (TB) Program has offered persons diagnosed with latent TB infection (LTBI) the 3-month, once-weekly isoniazid and rifapentine (3HP) treatment regimen. Patients on this treatment are monitored in-person under directly observed therapy (DOT). To address patient and provider barriers to in-person DOT, we piloted the use of a videoconferencing software app to remotely conduct synchronous DOT (video directly observed therapy; VDOT) for patients on 3HP.
The objective of our study was to evaluate the implementation of VDOT for patients on 3HP and to assess whether treatment completion for these patients increased when they were monitored using VDOT compared with that using the standard in-person DOT.
Between February and October 2015, patients diagnosed with LTBI at any of the four NYC Health Department TB clinics who met eligibility criteria for treatment with 3HP under VDOT (V3HP) were followed until 16 weeks after treatment initiation, with treatment completion defined as ingestion of 11 doses within 16 weeks. Treatment completion of patients on V3HP was compared with that of patients on 3HP under clinic-based, in-person DOT who were part of a prior study in 2013. Furthermore, outcomes of video sessions with V3HP patients were collected and analyzed.
During the study period, 70% (50/71) of eligible patients were placed on V3HP. Treatment completion among V3HP patients was 88% (44/50) compared with 64.9% (196/302) among 3HP patients on clinic DOT (P<.001). A total of 360 video sessions were conducted for V3HP patients with a median of 8 (range: 1-11) sessions per patient and a median time of 4 (range: 1-59) minutes per session. Adherence issues (eg, >15 minutes late) during video sessions occurred 104 times. No major side effects were reported by V3HP patients.
The NYC TB program observed higher treatment completion with VDOT than that previously seen with clinic DOT among patients on 3HP. Expanding the use of VDOT may improve treatment completion and corresponding outcomes for patients with LTBI.
自2013年1月起，纽约市卫生部门结核病项目为诊断为潜伏性结核感染（LTBI）的患者提供为期3个月、每周一次的异烟肼和利福喷汀（3HP）治疗方案。接受该治疗的患者在直接观察治疗（DOT）下进行当面监测。为解决患者和医护人员当面接受DOT的障碍，我们试点使用视频会议软件应用程序对接受3HP治疗的患者进行远程同步DOT（视频直接观察治疗；VDOT）。
我们研究的目的是评估VDOT在接受3HP治疗患者中的实施情况，并评估与使用标准当面DOT相比，使用VDOT监测这些患者时治疗完成率是否提高。
2015年2月至10月期间，对在纽约市卫生部门四个结核病诊所中任何一个被诊断为LTBI且符合VDOT（V3HP）下3HP治疗资格标准的患者进行随访，直至治疗开始后16周，治疗完成定义为在16周内服用11剂药物。将V3HP患者的治疗完成情况与2013年一项先前研究中接受基于诊所的当面DOT的3HP患者的治疗完成情况进行比较。此外，收集并分析与V3HP患者视频会议的结果。
在研究期间，70%（50/71）符合条件的患者接受了V3HP治疗。V3HP患者的治疗完成率为88%（44/50），而诊所DOT下的3HP患者为64.9%（196/302）（P<0.001）。共为V3HP患者进行了360次视频会议，每位患者的会议中位数为8次（范围：1 - 11次），每次会议的中位数时间为4分钟（范围：1 - 59分钟）。视频会议期间出现了104次依从性问题（如迟到超过15分钟）。V3HP患者未报告重大副作用。
纽约市结核病项目观察到，接受3HP治疗的患者中，VDOT的治疗完成率高于之前诊所DOT的情况。扩大VDOT的使用可能会提高LTBI患者的治疗完成率及相应结果。
