Use of Smartphone-Based Video Directly
Observed Therapy to Increase Tuberculosis
Medication Adherence: An Interventional Study
Manal M. Al Daajani1, Abdullah J. Alsahafi1, Abdullah M. Algarni1, Abdulhamed L. Moawwad1, Ahmed A. Osman2,
Khalid Y.A. Algaali3, Mohammed Abdalaziz4, Muhammad A. Halwani5, Shrooq M. Aldajani6, Nazik M. H. Moham-
med7, Heassah S. Alshamrani1, Mohammed N. Alshahrani1, Ghadah M. Albostani1, Naif G. Alshammari1, Rami S.
Alzahrani1, Saadiya O. Alsomali1, Ibrahim Assiri1
1 Public Health Department, Jeddah Health Aairs, Kingdom of Saudi Arabia (KSA)
2 Faculty of Medicine, Kassala University, Sudan
3 Public Health Operations Center, Ministry of Health, KSA
4 Infection Prevention & Control Department, King Abdulaziz Medical City Ministry of National Guard, Jeddah, KSA
5 Department of Microbiology, Faculty of Medicine, Al Baha University, KSA
6 Department of Oral and Maxillofacial Sciences, Vision (Al-Farabi) Colleges for Dentistry and Nursing, Jeddah, KSA
7 Faculty of Public Health and Health Informatics, Umm Al-Qura University, KSA
GMJ.2023;12:e3067
www.gmj.ir
Correspondence to:
Ahmed A. Osman, Faculty of Medicine, Kassala Uni-
versity, Sudan.
Telephone Number: +447707163553
Email Address: sudanup.ao@gmail.com
Received 2023-05-25
Revised 2023-06-06
Accepted 2023-06-13
Abstract
Background: Tuberculosis (TB) treatment through Directly Observed Therapy (DOT) has
an alternative form of video surveillance therapy (VOT) that utilizes the technological capa-
bilities of smartphones to provide patients with low-cost access to doctors without impacting
their work and personal life. We aimed to assess TB patients’ drug compliance, perceptions,
and feasibility towards smartphone-based video direct observed therapy (VDOT) in Jeddah,
KSA. Materials and Methods: We conducted a prospective non-randomized interventional
study. We delivered smartphone-based VDOT among previously unstudied patients to monitor
adherence to the treatment regimen. The expected total number of VDOT sessions was1200.
We conducted post-intervention interviews to assess acceptability and satisfaction. Results:
In this study, we included 20 participants, 16 of whom were males, with a mean age of 34.3
(±12.5) years. No side eects to the treatments were identied in all participants. The adher-
ence rate for the total period was 93% and 99.5%, measured by the rst and second methods,
respectively. Most participants were satised with the VDOT experience, the time spent on
sessions, and the approach’s privacy. Conclusion: This study provides promising results for the
feasibility and eectiveness of smartphone-based VDOT for TB treatment to increase adher-
ence which was indicated by a high compliance rate, acceptability, and high satisfaction level.
[GMJ.2023;12:e3067] DOI:10.31661/gmj.v12i0.3067
Keywords: MDR-TB; Medication Adherence; Saudi Arabia; Smartphone; Tuberculosis; VDOT
Introduction
World Health Organization (WHO) re-
ported that over 10 million people
worldwide develop tuberculosis (TB) annual-
ly. The vision for the post-2015 global tuber-
culosis strategy is “a world without tuberculo-
sis,” also expressed as “zero deaths, disease,
and suering due to tuberculosis.” Long-term
TB treatment for at least six months results in
drug discontinuation with a risk of developing
drug resistance, disease persistence, death,
and continued transmission of TB in the com-
munity [1]. In several infectious diseases in-
GMJ
Copyright© 2021, Galen Medical Journal.
This is an open-access article distributed
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Email:info@gmj.ir
Al Daajani MM, et al. Smartphone-Based Video Directly Observed Therapy and Tuberculosis Medication Adherence
2GMJ.2023;12:e3067
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cluding TB, human immunodeciency virus
(HIV), and hepatitis C, medication compli-
ance is a signicant factor leading to poor
patient outcomes and promoting the devel-
opment of drug-resistant tuberculosis (MDR-
TB) and the spread of the disease [2]. Part of
In-person-Directly Observed Therapy (DOT),
an observation made three to ve times a
week at home, in the community, or the clin-
ic, and it has been the standard of tuberculosis
care for addressing the problem of poor ad-
herence since the early 1990s published by
WHO [1, 3]. However, this approach carries
several limitations, including inconvenience
for patients and healthcare providers [3, 4].
Additionally, DOT relies heavily on interper-
sonal interactions for supervision and support,
which presents several challenges, particular-
ly in resource-limited settings and in patients
who are geographically distant and dicult to
reach [5].
WHO has recommended video-observed ther-
apy (VOT), which is daily remote monitoring
using a smartphone application and is an al-
ternative to in-person DOT by 2017 [3]. Video
directly observed therapy (VDOT) studies in
high, middle, and low-income countries indi-
cate that patients adhered to their treatment
regimens and reported high satisfaction levels
despite evidence associated with individual
DOT and tuberculosis treatment. have been
shown to achieve and often prefer VDOT.
Additionally, VDOT saves money for TB
programs by reducing travel and sta costs
[6-9]. Studies have looked at VOT alterna-
tives that have less impact on patient’s work
and family lives, more cost-eective, and im-
prove patients’ access to doctors by utilizing
the technological capabilities of smartphones
[10–12]. Patient-centered care increased as
the patients received VDOT as an option, ne-
cessitating ongoing communication, negoti-
ation, and cooperation between patients and
healthcare professionals [13].
With a funding gap (1.6 billion US dollars)
in TB treatment in low- and middle-income
countries, VDOT may be used to eectively
allocate medical resources [14]. Through pi-
lot studies collecting cost data, saving from
the use of electronic DOT (eDOT) ranged
from $1.811 to $14.355 per patient [15]. The
total number of new and recurrent tubercu-
losis cases in the Kingdom of Saudi Arabia
(KSA) in 2019 was 3004 cases, with an in-
cidence rate of (8.7) per 100,000 and a ther-
apeutic success rate of (89.9%). A private
DOT program was successfully implement-
ed in Jeddah. Subsequently, the Ministry of
Health (MOH) expanded it to include two
more provinces (Riyadh and Gazan districts)
[16]. The use of VDOT to treat TB patients
has been explored and considered by sever-
al prevention programs, especially after the
Coronavirus disease (COVID-19) pandemic
and lockdown. In this study, we aimed to as-
sess the feasibility and perceptions of smart-
phone-based video communication to support
adherence to tuberculosis medication among
patients in Jeddah Province, KSA.
Materials and Methods
The current study was a prospective sin-
gle-arm non-randomized interventional study
conducted in the National Tuberculosis Pro-
gram (NTP) in the Public Health Department,
Jeddah Health Aairs, KSA, from September
to November 2021. We retrieved participants’
data from the three health centers that pro-
vided TB treatment. Participants were chosen
based on inclusion criteria, which included
stable patients aged 18 years or older with
the drug-susceptible active pulmonary or ex-
trapulmonary disease, patients receiving rst-
line anti-tuberculosis drug therapy adminis-
tered only once daily orally with a xed-dose
combination (FDC) pill at an outpatient facil-
ity, and patients who discussed VDOT with
them and voluntarily provided informed con-
sent to allow their data to be used in future re-
search. The exclusion criteria comprised any
patients with MDR-TB or HIV, patients with
other health conditions that could interfere
with VDOT performance, including mental
illnesses, impaired vision, hearing, or speech
issues, patients who take pills more frequent-
ly than once per day, patients with drug con-
tradictions or allergies, and patients who are
incarcerated.
Based on practical considerations of recruit-
ment viability and resource availability, we
chose a small sample size of 20 participants
because we believed that this would be a pilot
study exploring the patients’ experience with
Smartphone-Based Video Directly Observed Therapy and Tuberculosis Medication Adherence Al Daajani MM, et al.
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3
the VDOT system. We used a quota sampling
technique. The NTP sta invited eligible pa-
tients sequentially during DOT visits at home
to enroll who met inclusion and exclusion cri-
teria and consented to participate in the study.
Intervention
The investigators were provided with VDOT
by a team trained by the Jeddah NTP. Re-
search sta explained VDOT to the patients,
asked them if they were interested and willing
to participate, and obtained written informed
consent. After that, we trained the sta and
participants to use online video call meetings
on their smartphones. By conducting a direct
synchronized live video to observe partici-
pants, we measured adherence rate by asking
the participants about their experience with
drug intake and adverse events. Both sta
and patients agreed on a regular pre-sched-
uled time set for all days of the week, and we
modied it if the patient’s preference changed
during treatment. We used the patient’s mo-
bile phones to remind them of appointments
and send them pill reminder notications
(via SMS) 30 minutes before each scheduled
pill time. For two months, we followed them
closely on the virtual platforms. If a patient
misses three appointments, one of the research
teams contacts them to resolve the concern.
Once the researcher recognized the partici-
pant’s non-compliance, they were counseled,
and a change to the scheduled pill time was
suggested, as this might solve the underlying
issue. At the end of the study period, the pills
were counted after participants returned the
pill bottles.
Outcome
We evaluated the adherence outcome in this
single-arm interventional study. All analyses
were based on the two months of follow-up.
The total expected VDOT sessions were 60
sessions per participant.
Treatment Adherence
We determined the adherence for each patient
in two ways: rst, by applying the equation
[(videos observation conrming pill intake
plus videos not received due to technical
problems)/videos expected] ×100 [4]. After
that, we measured adherence by pill count, an
indirect objective method, to conrm the re-
sult and minimize bias. Compliance was cal-
culated for each patient based on video ses-
sions outcome using the following formulae:
Adherence=(videos with observed dose in-
take-videos missed)/ (total expected videos
-videos with suspended intake) ×100 [4].
Conrmed adherence=[(OT+ONT) -
(M+R&M)]/(OT+ONT+M+R&M-S) ×100
[4].
Assumed adherence=[(OT+ONT+R&M)
-(M)]/(OT+ONT+M+R&M-S) ×100 [4].
OT=Doses observed on time. ONT=Dose
observed but not on time. M=Dose missed.
R&M=Received and Missed Dose in the vid-
eo. S=Suspension due to medical advice.
We used an interview questionnaire as a data
collection tool including age, sex, socioeco-
nomic characteristics, education, occupation,
relevant medical information (comorbidities),
VDOT sessions, and drug side eects. After
completion of the intervention (two-month
treatment period), we assessed feasibility,
acceptability, satisfaction rate, and general
perception among participants in a post-study
survey.
Data Analysis
We collected and entered data into Statistical
Package for Social Sciences (SPSS) version
22 (IBM Corporation, Armonk, NY, USA).
We conducted the statistical analysis using
continuous and categorical variables. We pre-
sented the continuous variables as a range,
whereas categorical were presented as num-
bers and percentages. We calculated frequen-
cies and means ± standard deviation (SD) to
summarize continuous variables. We applied
the Chi-square test in inferential statistics and
considered dierences in the results statisti-
cally signicant with a two-sided P≤0.05 and
95% condence interval (CI).
Ethical Considerations
Informed consent was obtained from the pa-
tients with a clear explanation of the purpos-
es of this study and they were able to termi-
nate their voluntary contribution at any time
without aecting their treatment Institutional
review board (IRB) approval was obtained
from Jeddah Health Aairs, KSA number:
H-02-J-002, Research No. 1544.
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Al Daajani MM, et al. Smartphone-Based Video Directly Observed Therapy and Tuberculosis Medication Adherence
Results
In this study, we included 20 participants with
a median age of 34.3 (±12.5) years (18 – 54
years). Eighty percent of them were males,
and 40% of them had a secondary school edu-
cation. More than half of the participants were
employed, and about 80% had a monthly in-
come of less than 3000 Saudi Arabian Rials
(SAR) (Table-1). The total expected VDOT
sessions were 1200 sessions.
Over the course of the study, we haven’t iden-
tied any side eects to the treatments in all
participants that could lead to treatment dis-
continuation. The mean duration (in minutes)
was 6.2 (±3.5) for the total period. More than
90% of participants were found to adhere to
most doses on time, suggesting a 93% overall
adherence rate as measured by the rst meth-
od.
Moreover, the adherence rate for the second
method reached (99.5%). There are no sta-
tistically signicant dierences between the
rst and second months in the duration, out-
come, and adherence (Table-2). According
to the prescribed management method, the
post-VDOT survey revealed the participants’
satisfaction level with the VDOT experience.
We found that four-fths of the participants
were satised with their VDOT experience,
the time spent on VDOT sessions, and their
privacy, while only one-fth were dissatised
with the VDOT experience.
The overall VDOT process feasibility was
described as very easy by three-quarters of
the participants (Table-3). We observed that
some participants experiences VDOT session
issues, for example a quarter had poor inter-
net connection and 15% had an internet sub-
scription. At the same time, two-fth of them
rarely had VDOT session issues or one-fth
had none at all.
We noticed that a considerable number of
participants (40%) took their sessions outside
their houses (Table-4). In this study, the partic-
ipants had several reasons to continue VDOT
in the future if it becomes available. One of
these reasons is the ease of use, reported by
40% of participants, and the ability to conduct
VDOT sessions from anywhere, which was
reported by one-quarter of the participants
(Table-5).
Generally, the participants’ perceptions about
using and recommending VDOT to other pa-
tients were 100% positive, as shown in (Ta-
ble-6.
Table 1. The Sociodemographic Characteristics of the Participants (N=20).
Characteristic Count(%)
Sex Male 16 (80%)
Female 4 (20%)
Age (in years)
The mean age 34.3 (±12.5)
years
10-19 2 (10%)
20-29 9 (45%)
30-39 1 (5%)
40-49 4 (20%)
50 years and above 4 (20%)
Education
Illiterate 4 (20%)
Primary school 1 (5%)
Middle school 1 (5%)
Secondary school 8 (40%)
University & above 6 (30%)
Occupation
Employed 11 (55%)
Student 6 (30%)
Unemployed 3 (15%)
Monthly income in SAR* Less than 3,000 16 (80%)
3,000 - 5,999 4 (20%)
* SAR: Saudi Arabian Rial
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Smartphone-Based Video Directly Observed Therapy and Tuberculosis Medication Adherence Al Daajani MM, et al.
Table 2. VDOT Adherence (N=20).
VDOT sessions Month 1 Month 2 Total period P-Value
Duration (in
minutes)
Mean (±SD) 7.4 (±3.1) 5 (±3.4) 6.2 (±3.5)
0.69
Median 5 4 5
Range 1-16 1-15 1-16
Outcome
OT* 554 (92%) 559 (93%) 1113 (93%)
0.68
ONT** 43 (7%) 38 (6%) 81 (7%)
M*** 2 (0%) 3 (1%) 5 (0%)
R&M† 1 (0%) 0 (0%) 1 (0%)
S†† 0 (0%) 0 (0%) 0 (0%)
Total 600 (100%) 600 (100%) 1200 (100%)
Adherence Conrmed 99.5% 99.5% 99.5% 0.99
Assumed 99.7% 99.5% 99.6% 0.99
* OT: Doses observed on time; ** ONT: Dose observed but not on time; *** M: Dose missed; † R&M: Re-
ceived and Missed dose in the video; †† S: Suspension due to medical advice.
Table 3. The Satisfaction Level, Privacy, and Easiness VDOT According to Participants’ Perception (N=20).
Satisfaction level Count (%)
General satisfaction level Satised 16 (80%)
Dissatised 4 (20%)
Satisfaction with time spent on
VDOT sessions
Very satised 16 (80%)
Satised 4 (20%)
Privacy on VDOT vs. in-person DOT
Higher 16 (80%)
Same 2 (10%)
Lower 2 (10%)
Overall VDOT process easiness
Very easy 15 (75%)
Somewhat easy 5 (25%)
Somewhat or very dicult 0 (0%)
Table 4. VDOT sessions issues and frequency of taking the treatment outside the house (N=20).
Sessions issues Count (%)
VDOT sessions issues
Network connectivity 5 (25%)
Internet subscription 3 (15%)
Rare 8 (40%)
Never 4 (20%)
Frequency of taking the treatment
outside the house
Most the times 8 (40%)
Rare or never 12 (60%)
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Al Daajani MM, et al. Smartphone-Based Video Directly Observed Therapy and Tuberculosis Medication Adherence
Table 5. Participants’ Reasons to Continue VDOT
Reasons to continue
VDOT Descriptions Count (%)
Easier to use Easiness of use 8 (40%)
Mobility Ability to conduct VDOT session from anywhere 5 (25%)
Easier communication Ease of communication with the team 4 (20%)
Lower cost/eort Saving time and eort of attending the clinic 3 (15%)
Privacy Higher privacy 1 (5%)
Table 6. Participants’ Perception about Using VDOT (N=20).
Participants’ perception Count (%)
If re-treatment is required, what would you choose? VDOT 20 (100%)
DOT 0 (0%)
Recommend VDOT to other TB patients Yes 20 (100%)
No 0 (0%)
Discussion
In this study, we included a total of 20 partic-
ipants who used smartphone-based video call
for conducting VDOT and were followed for
two months with a total of 1200 sessions. The
study found a high level of satisfaction (80%)
among participants and a very high level of
medication regimen adherence (99.5%) us-
ing the smartphone-based VDOT method. In
KSA, the non-compliance rate of DOT reach-
es 28% with an adherence rate of 72% [17].
Usually, the completion of 80% or more of
scheduled treatment observations is consid-
ered a success and the optimum rate of DOT
[18,19]. In comparison, the suboptimum level
of DOT is considered below 75% of comple-
tion of the treatment regimen [20]. A pilot proj-
ect conducted in India revealed that the over-
all adherence rate of VDOT was 96.03%, the
average adherence rate by call was 92.25%,
and the average adherence rate by in-person
DOT (standard DOT) was 32.12% [21].
The results of this study are consistent with
other studies on VDOT, which have also
found high levels of adherence and patient
satisfaction. For example, a survey conducted
in the United States aimed to assess the fea-
sibility and acceptability of VDOT. It was a
single-arm trial among TB patients, recruit-
ing 52 patients (from San Diego and Tijuana,
USA) with a mean age of 37 years; half were
male. The reported adherence rate with vDOT
was (93%) in San Diego and (96%) in Tijuana
[22]. Similarly, in India, Holzman et al. found
that VDOT was a feasible and eective meth-
od of TB treatment, with high levels of adher-
ence and patient satisfaction [23].
However, in this study, we found that some
participants reported some issues and dicul-
ties, including network connection and inter-
net subscription, as well as using the Facetime
application. This lack of resources was a po-
tential limitation of the method that should be
addressed for the future eective implementa-
tion of VDOT. Alternative video platforms or
training programs may need to be considered
to improve patient ease of use.
A study conducted in Ethiopia found that
VDOT was a feasible and eective method of
TB treatment, with high levels of adherence
and patient satisfaction. However, the study
also found that patients preferred in-person
DOT over VDOT, which may reect cultural
dierences in patient preferences and expec-
tations [24]. Our ndings are similar to other
results of previous studies conducted in South
Africa, which found that VDOT was a feasible
method of TB treatment, but also identied
concerns about privacy and condentiality
among patients. This concern has been iden-
tied in other studies and highlights the im-
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Smartphone-Based Video Directly Observed Therapy and Tuberculosis Medication Adherence Al Daajani MM, et al.
portance of addressing patient concerns and
ensuring the security of patient information
while using VDOT [25]. We noticed that many
participants felt comfortable using VDOT in
their houses or outside, which added value to
using VDOT versus in-person DOT. Overall,
these studies suggest that VDOT is a prom-
ising new method for TB treatment that can
improve adherence to medication regimens
and reduce the cost of TB treatment. Further
research is needed to fully understand the po-
tential benets and drawbacks of VDOT and
identify the best practices for its implementa-
tion in TB treatment programs, taking into ac-
count cultural and contextual factors that may
aect its feasibility and acceptability.
Conclusion
In conclusion, this study strongly conveys
the feasibility and eectiveness of smart-
phone-based VDOT for TB treatment in in-
creasing compliance, as evidenced by a high
adherence rate, acceptability, and high satis-
faction level among participants.
Conict of interest
The authors declare no conict of interest.
References
1. World Health Organization. Tuberculosis
Report 2020. Geneva: World Health Organi-
zation; 2020. Available from: https://www.
who.int/publications/i/item/9789240013131
2. Martin LR, Williams SL, Haskard KB,
DiMatteo MR. The challenge of patient
adherence. Therapeutics and clinical risk
management. 2005;1(3):189.
3. Story A, Aldridge RW, Smith CM, Gar-
ber E, Hall J, Ferenando G, et al. Smart-
phone-enabled video-observed versus
directly observed treatment for tuberculosis:
a multicentre, analyst-blinded, randomised,
controlled superiority trial. The Lancet.
2019;393(10177):1216-24.
4. Molton JS, Pang Y, Wang Z, Qiu B, Wu P,
Rahman-Shepherd A, et al. Prospective sin-
gle-arm interventional pilot study to assess a
smartphone-based system for measuring and
supporting adherence to medication. BMJ
open. 2016;6(12):e014194.
5. Rabinovich L, Molton JS, Ooi WT, Pa-
ton NI, Batra S, Yoong J. Perceptions and
acceptability of digital interventions among
tuberculosis patients in Cambodia: qualitative
study of video-based directly observed ther-
apy. Journal of Medical Internet Research.
2020;22(7):e16856.
6. Mirsaeidi M, Farshidpour M, Banks-Tripp
D, Hashmi S, Kujoth C, Schraufnagel D.
Video directly observed therapy for treat-
ment of tuberculosis is patient-oriented and
cost-eective. European Respiratory Journal.
2015;46(3):871-4.
7. Chuck C, Robinson E, Macaraig M, Alexan-
der M, Burzynski J. Enhancing management
of tuberculosis treatment with video directly
observed therapy in New York City. The In-
ternational Journal of Tuberculosis and Lung
Disease. 2016;20(5):588-93.
8. Hayward A, Garber E. TB Reach 5: to com-
pare the ecacy of video observed treatment
(VOT) versus directly observed treatment
(DOT) in supporting adherence in patients
with active tuberculosis. 2015.
9. Skrahina A, Falzon D, Rusovich V, Zhylevich
L, Dara M, Sinkou H, et al. Video observed
treatment for tuberculosis patients in Belarus.
Eur Respiratory Soc. 2017;49(3):1602049.
10. Ingram D. Video directly observed therapy:
Enhancing care for patients with active tuber-
culosis. Nursing2020. 2018;48(5):64-6.
11. Subbaraman R, de Mondesert L, Musiimenta
A, Pai M, Mayer KH, Thomas BE, et al. Dig-
ital adherence technologies for the manage-
ment of tuberculosis therapy: mapping the
landscape and research priorities. BMJ global
health. 2018;3(5):e001018.
12. Macaraig M, Lobato MN, Pilote KM,
Wegener D. A national survey on the use
of electronic directly observed therapy
for treatment of tuberculosis. Journal of
Public Health Management and Practice.
132018;24(6):567-70.
13. Garfe15in RS, Liu L, Cuevas-Mota J, Collins
K, Muñoz F, Catanzaro DG, et al. Tubercu-
losis treatment monitoring by video directly
observed therapy in 5 health districts, Cali-
fornia, USA. Emerging infectious diseases.
2018;24(10):1806.
14. World Health Organization. Global tubercu-
losis report 2022. Switzerland: WHO publi-
8GMJ.2023;12:e3067
www.gmj.ir
Al Daajani MM, et al. Smartphone-Based Video Directly Observed Therapy and Tuberculosis Medication Adherence
cations; Available from: https://www.who.int/
teams/global-tuberculosis-programme/tb-re-
ports/global-tuberculosis-report-2022
15. Centers for Disease Control and Prevention.
Electronic Directly Observed Therapy for
Active TB Disease. Philadelphia: Centers
for Disease Control and Prevention; 2019.
Available from: https://www.cdc.gov/nchh-
stp/highimpactprevention/promising-hip-in-
tervention.html.
16. Hani Jokhdar, Abdullah M Assiri, Ahmed
Mohamed Hakawi, Maha Al-Alawi, Naif
Alotaibi, Abdulrahman Alodayani, et al.
Program Manual 2021. KINGDOM OF
SAUDI ARABIA: Ministry of health; 2021.
Available from: https://www.moh.gov.sa/
Documents/National-TB-program-1.pdf.
17. Chaudhry LA Al-Tawq J Ba-Essa E Robert
AA. Low rate of non-compliance to antitu-
berculous therapy under the banner of di-
rectly observed treatment short course (dots)
strategy and well organized retrieval system:
a call for implementation of this strategy at
all dots centers in saudi arabia. The pan afri-
can medical journal. 2015:267-267.
18. Story A, Aldridge RW, Smith CM, Gar-
ber E, Hall J, Ferenando G, et al. Smart-
phone-enabled video-observed versus
directly observed treatment for tuberculosis:
a multicentre, analyst-blinded, randomised,
controlled superiority trial. The Lancet. 2019;
393(10177):1216-24.
19. Nahid P, Dorman SE, Alipanah N, et al.
Ocial American thoracic society centers
for disease control and prevention infectious
diseases Society of America clinical prac-
tice guidelines treatment of drug susceptible
tuberculosis. Clinical Infectious Diseas-
es.2016;63:e147–95.
20. World Health Organization. Golobal Tuber-
culosis Report 2016. Geneva: World Health
Organization; 2016. Available from: http://
apps.who.int/iris/bitstream/10665/250441/1/.
21. Thakkar D, Piparva KG, Lakkad SG. A pilot
project: 99DOTS information communica-
tion technology-based approach for tubercu-
losis treatment in Rajkot district. Lung India.
2019 Mar-Apr;36(2):108-111.
22. Garfein RS, Collins K, Muñoz F, Moser K,
Cerecer-Callu P, Raab F, Rios P, Flick A,
Zúñiga ML, Cuevas-Mota J, Liang K, Rangel
G, Burgos JL, Rodwell TC, Patrick K. Feasi-
bility of tuberculosis treatment monitoring by
video directly observed therapy: a binational
pilot study. Int J Tuberc Lung Dis. 2015
Sep;19(9):1057-64.
23. Holzman SB, Atre S, Sahasrabudhe T,
Ambike S, Jagtap D, Sayyad Y, Kakrani
AL, Gupta A, Mave V, Shah M. Use of
Smartphone-Based Video Directly Observed
Therapy (VDOT) in Tuberculosis Care: Sin-
gle-Arm, Prospective Feasibility Study. JMIR
Form Res. 2019 Aug 27;3(3):e13411.
24. Bommakanti KK, Smith LL, Liu L, et al. Re-
quiring smartphone ownership for mHealth
interventions: who could be left out? BMC
Public Health. 2020;20(1):81.
25. Sekandi JN, Kasiita V, Onuoha NA, et al.
Stakeholders' Perceptions of Benets of and
Barriers to Using Video-Observed Treatment
for Monitoring Patients With Tuberculosis
in Uganda: Exploratory Qualitative Study.
JMIR Mhealth Uhealth. 2021;9(10):e27131.
