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A National Survey on the Use of Electronic Directly Observed Therapy for Treatment of Tuberculosis

Macaraig, Michelle, DrPH; Lobato, Mark N., MD; McGinnis Pilote, Kara, MPH; Wegener, Donna, BA

Journal of Public Health Management and Practice: November/December 2018 - Volume 24 - Issue 6 - p 567–570
doi: 10.1097/PHH.0000000000000627
Research Reports: Research Brief Report

Context: An increasing number of tuberculosis (TB) programs are adopting electronic directly observed therapy (eDOT), the use of technology to supervise patient adherence remotely. Pilot studies show that treatment adherence and completion were similar with eDOT compared with the standard in-person DOT.

Objective: In December 2015, the National Tuberculosis Controllers Association administered an online survey to determine the extent to which eDOT is used in the United States.

Participants: Sixty-eight Centers for Disease Control and Prevention (CDC)–funded health department TB programs across the United States and a convenient sample of local health department TB programs.

Results: Fifty-six (82%) of 68 CDC-funded health department TB programs and an additional 57 local TB programs responded to the survey. Forty-seven (42%) of 113 TB programs are currently using eDOT, 41 (36%) are planning to implement it in the next year, and 25 (22%) have no plans to implement eDOT. Of the 47 TB programs using eDOT, 31 (66%) use synchronous video DOT, 4 (9%) asynchronous video DOT, 11 (23%) a combination of both, and 1 (2%) ingestible sensor to conduct electronic observations. Forty-one (87%) indicated that treatment adherence and 40 (85%) indicated that treatment completion were about the same or higher than in-person DOT. More than 80% indicated that eDOT resulted in program cost savings, and almost all (91%) reported benefits in patient and staff satisfaction. However, 25 (53%) of the 47 TB programs that use eDOT encountered technical challenges and 37 (79%) offer eDOT to less than a third of their patients.

Conclusions: Results from this survey indicate that eDOT is a promising tool that can be utilized to efficiently and effectively manage TB treatment. Findings will inform other TB programs interested in implementing eDOT. However, further evaluation is needed to assess eDOT acceptability to understand barriers to eDOT implementation from the patient and provider perspectives.

New York City Department of Health and Mental Hygiene, Queens, New York (Dr Macaraig and Ms McGinnis Pilote); Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Lobato and Ms McGinnis Pilote); and National Tuberculosis Controllers Association, Smyrna, Georgia (Ms Wegener).

Correspondence: Michelle Macaraig, DrPH, New York City Department of Health and Mental Hygiene, 42-0928th St, 21-42, Queens, NY 11101 (

The authors acknowledge the contributions of the eDOT survey workgroup in developing the survey and for its review of the survey findings, particularly Jennifer Kannouse, Lois Ritter, Ana Delia Hernandez, Annie Kizibash, Britteny Redick, Mei Kwong, Monica Rosales, Peri Hopkins, Peter Dupree, Rachel Yelk Woodruff, Rima Oken, and Sarah Segerlind. The authors also thank the National Tuberculosis Controllers Association and the Survey Committee for their support and Chee Kin Lam for his review of the article. The use of SurveyGizmo was made available through the National Tuberculosis Controllers Association.

The authors have no conflicts of interest and no financial disclosures.

The findings and conclusions in this article are those of the authors and do not necessarily represent the position of the Centers for Disease Control and Prevention.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

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