Lab Matters Winter 2020 - Page 6

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. 4 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 PublicHealthLabs @APHL APHL.org