PUBLIC HEALTH PREPAREDNESS AND RESPONSE
Using vDOT to Strengthen TB Control in Puerto Rico
and the US Virgin Islands
By Jill Sutton, associate specialist, Crisis Response
Hurricanes Irma and Maria caused
widespread destruction across the US
territories of Puerto Rico and the US
Virgin Islands, especially to public health
infrastructure. The back-to-back storms
resulted in many short and long-term
impacts, which limited the Puerto Rico
Department of Health’s (PRDOH) and the
US Virgin Islands Department of Health’s
(VIDOH) services for priority infectious
diseases, such as tuberculosis (TB)—one of
the world’s leading causes of death from
an infectious disease.
TB is both curable and preventable.
However, medication adherence is
critical to control the incidence and
prevalence of the disease. Poor adherence
leads to prolonged treatment and the
development of antibiotic resistant strains
of TB bacteria, which increases the risk
of transmission to others and makes TB
prevention and control even harder to
achieve. To help mitigate the effects of
poor adherence, health departments often
monitor the treatment of TB patients to
ensure they comply with their antibiotic
regimens.
Directly Observed Therapy (DOT)
Directly observed therapy (DOT) is the
traditional and most effective strategy
used to ensure medication adherence
for the treatment of TB. DOT requires all
patients undergoing treatment for TB
to meet with their healthcare provider
each time they need to take a dose,
which can be every day or multiple
times a week, depending on whether
the patient is undergoing treatment for
active TB disease or latent TB infection
(LTBI). Although transmission can only
be done by those with active TB disease,
prevention can be achieved if persons
with LTBI are also treated.
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LAB MATTERS Fall 2019
The emocha ® Mobile Health vDOT platform acts as an alternative to in-person
DOT and gives patients the ability to take their medication under remote
observation using a patient-facing mobile application.
In-person DOT can be logistically
challenging for both patients and
providers, especially after hurricanes or
other extreme weather events, which
can make DOT services less accessible,
thus increasing the risk of transmission
and development of antibiotic resistant
infections.
Implementation of vDOT to
Strengthen TB Prevention and
Control
To scale up TB prevention and control,
PRDOH and VIDOH implemented video
direct observation therapy (vDOT) to help
ensure patients receiving treatment for
LTBI can continue their TB therapy during
an unanticipated event.
The emocha ® Mobile Health vDOT
platform acts as an alternative to
in-person DOT and gives patients the
ability to take their medication under
remote observation using a patient-facing
mobile application. The application allows
patients to record and send videos after
each dose of their medication regimen.
The platform also consists of a web-based
portal for healthcare providers to review
patient videos, as well as monitor, track
and store new and historical patient data.
To support implementation of vDOT,
APHL procured smartphones for the
jurisdictions—30 for PRDOH and 15 for
USVIDOH—for the health departments
to have on hand and distribute to
patients that do not have access to or
own a smartphone. vDOT not only helps
ensure patients receiving treatment are
compliant, it also increases the capability
for both health departments to maintain
their TB prevention and control activities
before, during and after extreme weather
events or other public health threats. n
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