El Paso County DOT Tool
Directly Observed Therapy (DOT) is the gold standard for TB treatment because it ensures treatment and completion and prevents the development of antibiotic-resistant strains of TB. DOT involves having a health care provider watch a patient swallow all of their TB medication. This is typically done in-person at the patient's home. It is highly effective, but with most treatment requiring a minimum of three months for latent TB infection and a minimum of six months for active TB disease, DOT requires a significant commitment of resources and time for both the patient and they county TB program.
Widespread ownership of smartphones enabled use of technology to allow patients to submit videos of their treatment. El Paso County Public Health first implemented video-recorded DOT in 2017 and drastically reduced the time and cost associated with TB treatment. However, treatment via video requires strict adherence to quality standards such as keeping hands within the video frame, showing pills to the camera, and making it clear that the pills have been swallowed. Many patients struggled to produce videos that met the quality standards for treatment verification.
El Paso County Public Health has developed this video DOT tool kit to aid patients in producing daily, high-quality video recordings that clearly show them taking their TB medications while being able to remain in their homes while also allowing their health care providers to assure medication adherence.
Assembly and Use
Phone holder assembly
After acquiring the appropriate LEGO bricks (see the Resource tab), the simple phone holder can be assembled according to the pattern shown:
DOT Mat assembly
Print out all three pages of the DOT mat template (see the Resource tab) and align them to create a single 11 x 24 inch mat. Either affix the templates to sturdy cardboard or use clear packing tape to add strength and durability to the mat.
Placement of the DOT Mat
Choose a consistent location for video DOT to simplify daily setup and tear down. Have the patient sit in a chair facing a flat table with the assembled DOT mat in front of them, with the medication and water indicators on the side closest to the patient and the mat aligned with the edge of the table.
Place the phone in the phone holder with the camera function on in selfie mode. Adjust the position of the phone holder and the angle of the phone in the holder so that the patient's face and DOT mat are in view. Assure that the medication and water indicators are in view. Trace the location of the phone holder in permanent ink onto the DOT mat.
Daily use of the DOT Mat
Instruct the patient to assemble the video DOT setup the same way each day to ensure usable videos. The placement of the phone in the holder is especially important.
Click here to print the DOT mat. The mat can be assembled using basic office supplies as per the instructions in the Assembly and Use tab.
The phone holder is assembled from LEGO bricks (although other commercially available construction bricks will work.) Bricks are currently available for purchase from the LEGO "pick a brick" website: https://shop.lego.com/en-US/Pick-a-Brick
The necessary bricks for the construction as shown are:
- 1 "PLATE 4x8"
- 6 "BRICK 2x4"
These are available in a variety of fun and aesthetically pleasing colors. With 4-8 day shipping, the cost of one phone assembly is currently $6.67
Benefits and Cost Savings
Benefits of VDOT
- It allows patients to take their TB medications in their own home at a time that is most convenient for them. Traditional in-person DOT requires Public Health staff to go the patient’s home at a set time 5 days a week and observe them taking their TB medications
- VDOT allows patients greater privacy by not having Public Health staff show up every day.
- Public Health staff occasionally are not available to do in-person DOT due to a scheduled holiday or inclement weather. VDOT allows the patient to continue taking the TB medications as prescribed without having a disruption in their schedule.
- Because Video DOT is asynchronous – meaning the patient can record taking their medications at a convenient time – but the County worker can also view the recorded video at a time convenient for them, it allows for greater flexibility for both the patient and Public Health staff.
- Financial Savings
- Cost analyses show that VDOT over in-person DOT provides a significant savings in Public Health staff time and personnel costs to the TB Program.