In an Irish research first St James’ Hospital recruits patients with TB for Video Direct Observational Therapy study


A Health Innovation Hub Ireland (HIHI) pilot study with St James’ Hospital will investigate the benefits of using technology against in-person care in Tuberculosis (TB) medication adherence. In both the United Kingdom and the United States, the standard of care to ensure TB medication compliance is Video Direct Observational Therapy (VDOTS). The patient records a video ingesting medication remotely and submits securely via software to the TB nurse. Currently, in Ireland, a community nurse physically visits a patient with TB medication adherence, watches each take their medication and records it manually on a hard copy – this is Direct Observational Therapy (DOT).

Currently, a public health nurse visits a patient’s home either once or twice a day, within the traditional DOT system for TB in use across Ireland depending on the treatment plan. By contrast, VDOTS uses a mobile smartphone application that allows patients to remotely record and send videos of every medication dose ingested. The nurse then views the date and time-stamped videos on a secure web-based client management system (CMS) that is password protected. Once a patient’s videos are uploaded to the web portal, they are automatically deleted from the smartphone.

In 2018 in Ireland, there were 315 cases of TB notified with 38.4 per cent of total cases reported in Dublin. St James’ TB Clinical Nurse Specialist, Loraine Dolan approached HIHI to support the pilot study. The pilot will run for up to 18 months and test if VDOTS is superior to DOTS in recording doses of TB treatment that up to 40 Irish patients receive. The study will assess patient quality of life, cost-effectiveness and resource efficiencies e.g. nurse hours saved.  A similar UK study, published in The Lancet last year, found that the costs of providing DOT over six months were estimated at £5,700 per patient for observations five times per week and £3,420 for observations three times per week. For daily VOT over 6 months, costs were estimated at £1645 per patient.

Mary Day CEO St James’ Hospital said:

“As Irelands’ largest hospital, St James is committed to realising the full value of health technology and remote care to reduce the burden on the acute setting, achieve cost savings and empower our patients as active participants in their own care. We need this now more than ever.

 “This HIHI/St James’ pilot has been driven by ingenuity on the frontline through Lorraine, with the invaluable support of Health Innovation Hub Ireland whose Dublin office is based here in St James Hospital.”

Eimear Galvin, HIHI TCD Manager said:

“We opened doors in St James’ in 2018. As the acute site leader in digital health, basing part of the HIHI national network here means we can be very impactful. HIHI is very pleased to support this study stimulating frontline innovation and to have secured the software at no cost to the health service for the pilot duration.  The need for remote care and patient management that technology such as this delivers is even more urgent now since Covid-19.”

Lorraine Dolan TB Nurse Specialist and study PI said:

“TB is a curable disease; however the duration of treatment is lengthy ranging from six months to two years depending on the type and location of TB. The main aim of DOT is to ensure that patients take their medications each day and most importantly complete the treatment course.

 “Although not a complete replacement for DOTs, VDOTS empowers patients who can engage with it, to live their lives normally without constraints and interruption to their working day or home life with a nurse visit. This HIHI/St James study will be the first to offer the VDOTS option to TB patients.”

TB remains a global health threat. In 2018, 1.5 million people died from TB. TB now ranks as the leading cause of death worldwide from an infectious agent, resulting in more deaths than HIV and malaria (WHO, 2019). Globally there were 10 million new cases of TB in 2018. Directly observed treatment (DOT) has been the standard of care for tuberculosis since the early 1990s, but in some cases can be inconvenient for patients and service providers. The use of VDOT has emerged in the last decade with the improvements in technology as an alternative approach in ensuring compliance with TB treatment.

More about Irish Tech News and Business Showcase here.

FYI the ROI for you is => Irish Tech News now gets over 1.5 million monthly views, and up to 900k monthly unique visitors, from over 160 countries. We have over 860,000 relevant followers on Twitter on our various accounts & were recently described as Ireland’s leading online tech news site and Ireland’s answer to TechCrunch, so we can offer you a good audience!

Since introducing desktop notifications a short time ago, which notify readers directly in their browser of new articles being published, over 50,000 people have now signed up to receive them ensuring they are instantly kept up to date on all our latest content. Desktop notifications offer a unique method of serving content directly to verified readers and bypass the issue of content getting lost in people’s crowded news feeds.

Drop us a line if you want to be featured, guest post, suggest a possible interview or just let us know what you would like to see more of in our future articles. We’re always open to new and interesting suggestions for informative and different articles.

If you would like to be featured in our podcast series drop us a line & don’t forget to sign up for notifications for our latest episodes and follow us on Twitter, Linkedin, SoundCloud, iTunes or your own favourite podcast platform.

Contact us, by email, Twitter or whatever social media works for you and hopefully, we can share your story too and reach our global audience. We are agile, responsive, quick and talented, we look forward to working with you!

If you would like to have your company featured in the Irish Tech News Business Showcase, get in contact with us at [email protected] or on Twitter: @SimonCocking