Treatment and containment of active tuberculosis (TB) remains a serious global public health concern. In 2014, an estimated 9.6 million people fell ill with TB, and an estimated 1.5 million people died from the disease. The disease continues to takes its toll in Minnesota as well—in 2014, 147 cases of TB were reported in the state.
TB is generally treatable and curable with a course of antibiotic treatment that lasts for six to nine months, but it can be fatal if not treated properly. Patients who do not complete their drug regimen as prescribed are at risk for developing and transmitting dangerous, drug-resistant TB. To ensure people adhere to their treatment regimens, directly observed therapy (DOT) is considered the global standard of care. DOT is a method in which a health care worker watches the patient swallow each dose of the prescribed medication.
In-person DOT can be time-consuming and costly to administer, especially in rural communities where a health care worker may have to travel a significant distance for home visits. It may also be inconvenient for patients, who need to be accessible to the health care worker every time they take their medication.
Telemedicine may provide an effective means to monitor patient adherence to TB treatment regimens. Some local health departments in the United States and elsewhere have piloted the use of video directly observed therapy (VDOT) in which health care providers observe patients taking their TB medication remotely via a webcam, tablet, videophone, or smartphone. VDOT allows for monitoring of medication via video without routine in-person visits from public health providers.
There appears to be a growing interest among local health departments in Minnesota and in other jurisdictions to utilize innovative approaches in the treatment of TB. VDOT appears to be a promising alternative to traditional DOT practices and has the potential to improve TB control efforts in Minnesota and in other jurisdictions. However, there are legal, regulatory, and practical challenges relating to the use of VDOT, and the implementation of VDOT in Minnesota will not be immediate or simple. This Issue Brief summarizes some of the laws and regulations implicated by the use of VDOT in Minnesota, including legal permissibility, HIPAA privacy and security issues, data practices and health record issues, and reimbursement. The goal of this Issue Brief is to provide a starting point for local health departments to discuss with their legal counsel when considering the integration of a VDOT program into their TB control program efforts.