Research Summary

Technology for TB: Mobile phone based directly observed treatment for supporting adherence to antitubercular treatment in India

Widespread prevalence, prolonged treatment and emergence of drug resistant strains resulting from suboptimal adherence to treatment makes tuberculosis a disease of public health importance both globally and in India.

The current Indian guidelines for tuberculosis recommend an alternate day, directly observed treatment (DOT) regimen that will soon transition into a daily treatment regimen. Given this scenario, the logistics of daily treatment along with factors such as, forgetfulness, stigma, loss of wages and medication side effects, pose barriers to treatment adherence and completion.

The ubiquity of mobile technology presents a unique opportunity to support tuberculosis treatment. However, evidence indicates the need for family, peer or counseling support along with such mobile phone interventions.

This study proposes an alternative to in person DOT with mobile phone based video DOT along with counseling support. For this, patients will send in a video of themselves taking medications via their mobile phone and receive monthly adherence counseling (video DOT).

The effectiveness of video DOT will be studied in a Randomized Controlled Trial (RCT) in treatment naïve tuberculosis patients. Consenting patients will be divided into two groups of 190 patients each, with an equal chance of being allocated to either group. One group will receive the video DOT intervention, while the other, the prevailing standard of care. Treatment completion and adherence along with the multidimensional impact of tuberculosis on the individual, i.e., costs of care, nutritive status, quality of life and emergence of multidrug resistance, will be studied over time. Perceptions regarding the intervention, studied through in-depth interviews in a subset of participants and analysed with a qualitative approach will assess if the intervention is patient centric and user friendly.

Figure Legend: Mobile phone based direct observed treatment, RCT Design * Antitubercular treatment