Feasibility of Using Video Visits for Direct Observation of Treatment of Latent Tuberculosis With Twelve Weekly Doses of Isoniazid and Rifapentine

Abstract

Background. Video visits (VV) have been used for direct observation of treatment (DOT) of active tuberculosis with good results and patient acceptance. Treatment of latent tuberculosis infection (LTBI) using 12 weekly doses of isoniazid (INH) and rifapentine (3HP) is an alternative to a nine month course of INH and requires DOT. This requirement may be a barrier to acceptance of this treatment regimen by both patients and providers. We used VV for 3HPDOT tomake treatment of LTBI easier andmore convenient. Methods. Nine adult patients who were referred to the Infectious Disease service for treatment of LTBI were offered 3HP using VV or a standard course of INH with monthly telephone visits. Patients had access to a secure video application through a smart phone or computer. Each VV was conducted by a physician in the patient's preferred language and included a review of medications and side effects and observation of the patient swallowing the dose. We reviewed electronic records to assess feasibility and acceptability of this approach. Results. The mean age of the patients was 40 years (range 23 to 61). All nine patients had a positive PPD or gamma interferon test or both. Indications for treatment included use of biologicals (2), diabetes (1), immigration within 5 years (4), healthcare worker (2) and gastric bypass (1). There were no treatment discontinuations and each of the nine patients completed all doses in 12 weeks. VV were conducted in patients' homes, workplaces, cars and on vacation. Ninety eight of 108 VV were completed successfully. Reasons for failed VV were technical problems (8) and international travel without VV access (2). Six of 10 failed VV were accounted for by review of patient self-collected video. Each VV took approximately two minutes. VV were free for the patients who saved from $120 to 360 in copays for 12 visits. Of six patients who completed a survey at the end of treatment, all rated the VV 3HP as excellent and strongly preferred VV to in person visits for DOT. Conclusion. Using VV for DOT of 3HP is convenient, flexible and well accepted by patients who have smart phones or computer access. The ease of VV for DOT could encourage more providers to screen and treat patients with LTBI.