People with TB require lengthy treatment with regular doses of drugs, and patients often need support to help them complete medication. Led by UCL and UCLH, a world-first randomised controlled trial of online Video Supported Care (VSC) for tuberculosis treatment1 demonstrated that VSC was cheaper and more effective than standard face-to-face observation, leading to its adoption internationally.
TB causes 1.5million deaths annually, the biggest infectious killer after COVID-19. Treatment requires 6-months of pills to be taken regularly. Some cases, known as multidrug-resistant tuberculosis (MDRTB), require up to 24 months of intensive and complex treatment. The side effects of this demanding medication regime and the temptation to stop when symptoms improve make completing treatment challenging, especially for those with complex social circumstances. The World Health Organisation therefore recommends Directly Observed Treatment (DOT) to support all TB patients.
In the UK DOT is recommended for patients who have a history of poor adherence, those with previous TB, MDRTB, HIV, and socially complex patients including homeless people, drug users, prisoners, and those with alcohol and mental health problems. However, drawbacks to DOT include high cost, inconvenience, and stigma.
Instead of attending a healthcare site daily or three times a week, VSC users use a secure smartphone app to take a video of themselves taking their medication and the app shares the footage with health workers remotely, who check it against a timestamp to ensure the correct dosage has been taken at the right time.
The UCL VSC trial recruited patients eligible for DOT in 22 clinics in London, Leicester and Birmingham. 58% of participants had a history of homelessness, drug use, imprisonment, alcohol problems or mental health issues. The trial provided free smartphones and data plans for participants. 70% of VSC patients successfully completed over 80% of their scheduled treatment observations over six months compared to 31% of DOT patients. VSC costs were estimated at £1645 per patient over 6 months compared to £3420-£5700 for DOT.
This research informed WHO’s technical requirements for VSC platforms in patient care. WHO now recommend VSC as an alternative to DOT, with high uptake in North America, Eastern Europe and China. VSC is now recommended by NHS-England and used as the standard approach for MDRTB and socially complex patients. UCLH deliver the national VSC service for tuberculosis in England.
1. Lancet, Story A, etal, 2019
