1367. Tele-TB: Using TeleMedicine to Increase Access to Directly Observed Therapy for Latent Tuberculosis Infections

Abstract

Background. Otherwise healthy patients with latent tuberculosis infection (LTBI) have a 10 percent lifetime risk of progression to active TB disease. This risk is higher in recently exposed persons, young children, and the immunocompromised. Treatment of LTBI decreases the risk of progression. However, traditional treatment regimens required either daily isoniazid (INH) for 9 months, with historically poor compliance, or 12-week directly-observed therapy (DOT) with INH and rifapentine (RPT), with improved compliance but challenges of coordinating weekly clinic visits, further complicated if patients must travel a great distance for care and/or miss considerable amounts of time from work or school to attend encounters. Methods. Our referral area is complicated by congested traffic often resulting in one-way commutes in excess of 2 hours. These travel times would be prohibitive for conducting traditional weekly in-clinic DOT. In an effort to improve access to DOT, we implemented TeleMedicine LTBI DOT within a military pediatric infectious diseases clinic. Local providers were requested to refer patients aged two and older diagnosed with LTBI to our DOT TeleMedicine clinic. All patients without absolute contraindications for receiving INH and/or RPT were offered LTBI treatment via weekly TeleMedicine DOT or daily INH. If the family opted for TeleMedicine DOT, the first visit was performed in person to discuss treatment options, demonstrate use of the TeleMedicine software, and to ensure the patient was able to take the medications. Baseline information about patient travel time to our facility for patients enrolled in the LTBI DOT clinic was determined. Results. To date, seven patients have completed LTBI treatment via TeleMedicine DOT. Average one-way travel time to our facility for patients participating in the TeleMedicine DOT was 72 minutes. Actual time spent in the TeleMedicine DOT encounters was less than 10 minutes. Appointments were arranged to take place outside usual school and work hours so patients could complete DOT with minimal interruptions to daily life, resulting in 100% treatment compliance and completion. Conclusion. Conducting DOT using TeleMedicine is a viable and time-saving measure that still allows for high levels of patient compliance and treatment completion while minimizing interruptions to academic and work schedules. (Figure Presented).