Virtual appointments help tuberculosis patients stick to treatment

Video Supported Care (VSC) for tuberculosis treatment is cheaper and more effective than face-to-face support, according to a UCL and UCLH medical trial which has led to its global adoption.

Tuberculosis causes 1.5 million deaths per year, the biggest infectious killer after COVID-19. Treatment requires six months of pills to be taken regularly. Some cases, known as multi-drug resistant tuberculosis (MDRTB), do not respond to this approach and require up to 24 months of intensive and complex treatment.  

The side effects of this demanding medication regime make completing treatment challenging, especially for those with high levels of need or complex circumstances. The World Health Organisation (WHO) therefore recommends Directly Observed Treatment (DOT) to support tuberculosis patients.  

In the UK, DOT is recommended for patients who have a history of missing doses, those with previous tuberculosis, MDRTB, HIV, and socially complex patients including homeless people, drug users, prisoners, and those with mental health problems. However, drawbacks to DOT include high cost, inconvenience, and stigma.  

Cost and care benefits of virtual appointments  

Instead of attending a healthcare site multiple times a week, VSC users use a secure smartphone app to take a video of themselves taking their medication. 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 was led by Professor Andrew Hayward (UCL Institute of Epidemiology and Health Care) and recruited patients eligible for DOT in 22 clinics in London, Leicester and Birmingham. A total of 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 £1,645 per patient over six months, compared to £3,420-£5,700 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 recommended by NHS England and used as the standard approach for MDRTB and socially complex patients. Indeed, UCLH delivers the national VSC service for tuberculosis in England.  

The research team also included Professor Ibrahim Abubakar, Professor Robert Aldridge and Dr Alistair Story. 

Links

• Professor Andrew Hayward’s academic profile 
• Professor Ibrahim Abubakar’s academic profile 
• Professor Robert Aldridge’s academic profile 
• Dr Alistair Story’s faculty profile 
• UCL Institute of Epidemiology and Health Care 
• UCL Faculty of Population Health Sciences 
• UCL Faculty of Population Health Sciences REF 2021
• University College London Hospitals NHS Foundation Trust (UCLH) 

Image 

• Image credit: iStock/ Chainarong Prasertthai