Investigating the efficacy of integrating video-directly observed therapy (VDOT) in the treatment of tuberculosis (TB): A statewide analysis from Florida.

ABSTRACT

Objectives: To determine if integrating VDOT into TB therapy demonstrated non-inferiority to direct observation, and if VDOT utilization increased across Florida after the onset of Covid-19. Methods: A statewide programmatic review was conducted of all patients in Florida who initiated tuberculosis treatment between January 2018 - December 2018 and January 2020 - December 2021, as documented by the Florida Department of Health. Results: 1361 patients received treatment within the analysis timeframe. Therapy completion was 97.2% in those utilizing VDOT compared to 92.3% utilizing only DOT (p=<.001). Average duration of therapy was 220.5 days in the DOT-only cohort compared to 211.1 days with VDOT integration (p=.027). A 176.35% increase in VDOT utilization was seen across Florida during Covid-19. Conclusions: This is the first and largest state-wide study evaluating the efficacy of integrating VDOT into TB therapy, finding statistically significant improvements in completion and duration of therapy. Despite increased VDOT utilization since the onset of Covid-19, we suspect that multiple barriers may be hindering further integration. VDOT should be recommended as a cost effective, non-inferior alternative to DOT in monitoring the treatment of tuberculosis.