A technology-driven approach to treating tuberculosis will save money and offer convenience and privacy to patients, according to two counties testing the new method.
It’s called VDOT — short for video directly observed treatment — and it uses daily video chats and video recordings rather than face-to-face interaction with nurses.
“It’s a way to give the patient a little more autonomy,” said Sarah Gordon, TB control program manager for the Minnesota Department of Health.
Daily in-person checks to monitor side effects and deliver medicine long have been the gold standard for treating active TB. It’s a sometimes grueling six- to 12-month process that costs $16,000 to $18,000 a person.
But VDOT is winning positive reviews, with Dakota County estimating $1,500 in savings per patient.
“It’s a time saver and a money-saver for us,” said Renee Frauendienst, Stearns County public health director.
Minnesota clinics see between 150 and 180 TB cases annually, and the number has increased over the past three years. An outbreak in 2017 of drug-resistant TB in Ramsey County infected 17 people, killing three of them.
Many think TB was eradicated years ago, but about 10,000 Americans are diagnosed annually with it, according to the Centers for Disease Control and Prevention.
In 2017, more than 70 percent of those diagnosed were born outside the U.S., including in Africa and Asia, where the disease is common. The percentage of foreign-born TB patients in Minnesota is over 80 percent, experts said.
Dakota County is first in the state to try VDOT, starting with a pilot earlier this year. The county so far has seen 16 reported cases of TB in 2018, with 11 of those confirmed, said Christine Lees, Dakota County’s public health supervisor. That’s on the high end of the county’s typical range.
Five clients participated in the pilot and eight are using the video treatment now, Lees said. The county uses technology provided by the state Department of Human Services, which keeps costs down.
Stearns County piggybacked on Dakota’s efforts, trying the video method this spring with one client. The county has seen a “significant increase over the years” in TB cases, Frauendienst said, with nine last year.
Hennepin County’s Public Health Clinic plans to participate in a VDOT study and is talking with a software vendor that can provide the necessary technology, said Dr. Bryan Rock. He’s an infectious disease doctor with the clinic, which he said sees about half of all TB patients in Minnesota.
Kristen Virdone, who works in the California tech industry, calls VDOT “a really clever idea.” She contracted tuberculosis three years after a globe-trotting stint with her husband, and soon found that the intense antibiotics regimen — which involves daily visits from a nurse for up to a year — was time-consuming and interfered with her work.
But Virdone had the chance to try VDOT. She filmed herself taking up to nine pills a day and sent the video to the clinic, rather than having a nurse stop by to confirm she was taking her medicine.
“That just gave me so much more freedom,” she said.
Enhancing patient care
TB is caused by a bacterial infection and is curable if treated. It usually affects the lungs, though the bones, spine or other organs also can be infected. Thousands of Americans used to die each year of TB, also known as consumption. But by the 1950s, advances in antibiotics had greatly reduced the risk of becoming infected.
Lees said that the use of video helped make this spring’s surge in TB cases more manageable. Because of VDOT and the time savings it provides, nurses can now take on larger caseloads.
“Public health departments are always looking for ways to save money,” she said. “Funding … goes up and down.”
Most clients loved the video platform, Lees said, because it allowed them to work around job schedules or fasting during Ramadan.
Eliminating travel — which can take an hour one way — to even one patient’s home will save money, Frauendienst said, adding that the technology benefited patients as well.
“In no way did we feel that we compromised the care of that individual,” she said. “In fact, I think we kind of enhanced it.”
Rock said the video approach is less intrusive and helps alleviate some patient concerns related to nurse visits. For instance, some patients are shy or private about the disease, while others — like long-haul truckers — have jobs where traditional visits just don’t work.
In addition, a stigma continues to surround TB, Rock said. Some patients don’t want their neighbors to see a nurse checking on them regularly because they fear their diagnosis will be discovered.
Public health officials caution, however, that using video doesn’t work for all cases, especially complicated ones. And some patients using VDOT may feel it makes for less of a relationship with their nurses, Rock said.
Companies providing the technology may make it too expensive for some public health programs, he said. Also, the technology must protect privacy and comply with HIPAA, the federal regulations protecting patients’ health information.
“You can’t simply just do FaceTime,” Rock said.
But Kristi Mathis, 29, an account executive in Detroit, wishes she’d had another option. She acquired TB while in the Peace Corps in Malawi and was diagnosed in 2016.
Mathis said she found the daily check-ins paternalistic, and would have much preferred video communication. “It would have been a lot more convenient,” she said.