Programmatic adoption and implementation of Video-observed therapy in Minnesota: Prospective Observational Cohort Study (Preprint)

<sec> <title>BACKGROUND</title> In-person directly observed therapy (DOT) is commonly used for tuberculosis (TB) treatment adherence monitoring in the US, with increasing usage of video-DOT (vDOT). In Minneapolis, vDOT became available in 2019. </sec> <sec> <title>OBJECTIVE</title> We aimed to evaluate the programmatic utilization and effectiveness of vDOT over time, and the impact of COVID-19 on TB treatment adherence and technology adoption. </sec> <sec> <title>METHODS</title> We abstracted routinely collected data on individuals receiving therapy for TB disease in Minneapolis, MN between September 2019 and June 2021. Our primary outcomes were to assess vDOT utilization and treatment adherence, defined as the proportion of prescribed doses (7 days per week) verified by observation (in-person versus video-DOT), comparing individuals receiving therapy in the pre-COVID (before March 2020), early-COVID (March-August 2020), and intra-COVID (after August 2020) period. </sec> <sec> <title>RESULTS</title> Among 49 TB patients (mean age 41, 55% female, 96% non-US born), 18 (36.7%) received treatment during the COVID-19 pandemic. Overall, verified adherence (proportion of observed doses) was significantly higher when using vDOT (median 86% [IQR 71-99%]) compared to in-person DOT (median 57% [47%-63%], P=.001). The adoption of vDOT increased significantly from 35% of TB patients in the pre-COVID period, to 67% in the post-COVID periods (P=.035). Consequently, overall verified (i.e., observed) adherence among all TB patients in the clinic improved across the study periods (56%, 67%, 79%, P=.001 for the pre-, early-, intra-COVID periods, respectively). </sec> <sec> <title>CONCLUSIONS</title> vDOT utilization increased post-COVID, was more effective than in-person DOT at verifying ingestion of prescribed treatment, and led to overall increased verified adherence in the clinic despite the onset of the COVID-19 pandemic. </sec>