Medicine - Infectious Diseases
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Using Mobile Technology for Tuberculosis Treatment in India: A Pilot Feasibility Study
Tuberculosis (TB) is a significant cause of mortality in India, which at 2.2 million cases diagnosed annually reports the highest number of incident cases in the world. While TB is curable, the delivery of care in India remains challenging; treatment default has been found to be 18% in some settings, spurring the rise of drug-resistance. The World Health Organization recommends directly observed therapy (DOT) for the treatment of TB to improve outcomes. In India this involves patients traveling to health centers to receive medications and be observed. This is labor-intensive, logistically challenging, and expensive for patients and programs. An alternative strategy is to view patients “at a distance” through video recorded with a mobile device. With India having 900 million cell phone users, this ‘video-based directly observed treatment’ (video-DOT) offers convenience to patients; it also offers reduced staff burden and reduced expense. A prototype application, miDOT (mobile internet DOT), has been developed at Johns Hopkins University (JHU) to allow video-DOT and TB monitoring on mobile devices and computers. We propose to evaluate the feasibility of using miDOT in public TB programs, to assess patient and provider acceptability of miDOT, and to perform a cost comparison of miDOT and conventional DOT. Given the significance of the global TB problem the results of this work may lead to large randomized controlled trials. We will conduct our project in collaboration with two sites that have established research partnerships with JHU, namely, B.J. Medical College and Padmashree Dr. D.Y. Patil Medical College (Pune, India).