Video Directly Observed Therapy for TB Treatment in Haitian Correctional Facilities Open Access

Dirks, Laura (Spring 2020)

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Introduction: Tuberculosis causes significant morbidity and mortality but can be cured through an intensive drug regimen. Providing WHO recommended directly observed therapy has not been possible in settings lacking medical personnel. As a result, many individuals with TB lack adequate therapy. In 2017, 142 individuals incarcerated in Haitian correctional facilities remained at sites unable to provide proper care. We sought a solution for the delivery of observed therapy in low resource prison settings.

Methods: Correctional officer-facilitated VDOT was implemented in four low resource correctional facilities in Haiti. Regimen adherence was tracked using asynchronous VDOT software monitored remotely by medical staff. In the event of VDOT failure, correctional officers delivered in-person therapy. In addition to the primary outcome of adherence, the program was evaluated using the RE-AIM framework.

Results: Median VDOT adherence for 65 individuals enrolled was 81.8%. Median total adherence, including doses delivered by correctional staff, was 99.1%. Adherence varied significantly by site but was not associated with any demographic characteristics. Correctional officers reported high interest in the program and high comfort with its technology.

Conclusion VDOT can provide TB treatment in low resource correctional facilities. It facilitates observed therapy, and enables continuous patient monitoring, and treatment follow-up, which these sites historically lacked. Implementing VDOT for TB treatment could expand treatment in correctional facilities in Haiti and be used in prisons in other low resource areas facing similar challenges.

Table of Contents

Introduction 1

Problem statement 3

Purpose statement 4

Research question 4

Significance statement 4

Definition of terms 5

Review of Literature 5

Tuberculosis in Low-Income Correctional Facilities 7

TB in Haiti 8

Health in Haitian Prisons 9

Health through Walls 11

Video Directly Observed Therapy 12


Methods 17

Diagnosis of TB 17

The VDOT Intervention 18

Study Design 19

Evaluation 21

RE-AIM: The RE-AIM framework was used to assess various aspects of VDOT implementation 23

Ethical Consideration 27

Limitations 27

Results 29

Reach 29

Effectiveness 31

Adoption 32

Implementation 33

Maintenance 35

Discussion 35

Recommendations 39

Conclusions 40

Resources 41

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