UCL Institute of Health Informatics


Video observed therapy for TB

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Video Observed Therapy for TB – The world’s first randomised controlled trial of smartphone-enabled  'Video Observed Therapy' to support patients to complete tuberculosis treatment.

The Problem

Despite availability of affordable treatment, 9.6 million people fell ill with TB in 2014 and 1.5 million died. Nearly half a million people developed multidrug-resistant tuberculosis. A key challenge is ensuring that patients complete at least six months of treatment, to prevent treatment failure, development of drug resistant disease and spread of infection. The World Health Organization recommend Directly Observed Therapy (DOT) for tuberculosis, whereby treatment doses are observed in person by a health care worker or other responsible adult. In the UK DOT is recommended for patients who are thought to be at high risk of failing to take their treatment, particularly in socially complex cases such as those with a history of homelessness, drug use and imprisonment. DOT can be challenging to deliver and inconvenient for both patients and health service providers. Video Observed Therapy (VOT), where treatment observation is conducted remotely by asking patients to submit video clips of themselves taking their treatment via smartphones, has emerged as a potential solution. 

Our Research

Through the NIHR TB Reach programme we are leading the world’s first randomised controlled trial of VOT for TB among TB patients in the UK using a smartphone app developed by the University of San Diego. 

Professor Hayward, study Chief Investigator said, 'Making sure that patients with TB can take their treatment effectively is central to TB control worldwide. In the UK many of our patients have complex social problems such as homelessness and addiction problems. This is a really great example of how simple, low-cost mobile-health interventions can improve patients’ lives and contribute to control of a major public health problem. Although we know patients like the convenience of not having to go into clinic, trials are important to understand feasibility, prove effectiveness and  provide the evidence for widespread adoption nationally and internationally. We will publish the trial results in 2016. The study is already having global impact – we are advising the World Health Organization on development of a technical specification for VOT apps and collaborating on a further trial of VOT in Eastern Europe. The emergence of multidrug-resistant strains requiring sustained adherence to prolonged treatment means the world is losing the fight against TB. The rapidly increasing global availability of cheap smartphones means that VOT could soon be an important part of TB control programmes internationally.' 


Citizen driven health

Precision medicine

Read more about Video Observed Therapy

Story A, Garfein R, Hayward A, et al. Monitoring Therapy Compliance of Tuberculosis Patients by using Video-Enabled Electronic Devices.  Emerging Infectious Diseases 2016. Vol 22.  March 2016

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