Computer created image of a human at a table with a paper guide and cell phone for direct observational therapy (DOT)

El Paso County DOT Tool

Directly Observed Therapy (DOT) is the gold standard for TB treatment because it ensures treatment and completion and prevents the development of antibiotic-resistant strains of TB. DOT involves having a health care provider watch a patient swallow all of their TB medication. This is typically done in-person at the patient’s home. It is highly effective, but with most treatment requiring a minimum of three months for latent TB infection and a minimum of six months for active TB disease, DOT requires a significant commitment of resources and time for both the patient and they county TB program.

Widespread ownership of smartphones enabled use of technology to allow patients to submit videos of their treatment. El Paso County Public Health first implemented video-recorded DOT in 2017, drastically reducing the time and cost associated with TB treatment. Producing high-quality videos ensures successful treatment and requires following standards set by the Colorado Department of Health and Environment. El Paso County Public Health has developed this video DOT tool kit to support our patient’s ability to complete their treatment with greater independence.

Assembly and Use

Phone holder assembly

After acquiring the appropriate LEGO bricks (see the Resource tab), the simple phone holder can be assembled according to the pattern shown:

Lego brick phone holder

DOT Mat assembly

Print out all three pages of the DOT mat template (see the Resource tab) and align them to create a single 11 x 24 inch mat. Either affix the templates to sturdy cardboard or use clear packing tape to add strength and durability to the mat.

Placement of the DOT Mat

Choose a consistent location for video DOT to simplify daily setup and tear down. Have the patient sit in a chair facing a flat table with the assembled DOT mat in front of them, with the medication and water indicators on the side closest to the patient and the mat aligned with the edge of the table.

Place the phone in the phone holder with the camera function on in selfie mode. Adjust the position of the phone holder and the angle of the phone in the holder so that the patient’s face and DOT mat are in view. Assure that the medication and water indicators are in view. Trace the location of the phone holder in permanent ink onto the DOT mat.

Daily use of the DOT Mat

Instruct the patient to assemble the video DOT setup the same way each day to ensure usable videos. The placement of the phone in the holder is especially important.

Computer created image of a human at a table with a paper guide and cell phone for direct observational therapy (DOT)

Resources

DOT Mat

Click here to print the TB DOT Mat. The mat can be assembled using basic office supplies as per the instructions in the Assembly and Use tab.

Phone Holder

The phone holder is assembled from LEGO bricks (although other commercially available construction bricks will work.)

Image of building block bricks to create a phone holder for DOT.

The necessary bricks for the construction as shown are:

  • 1 “PLATE 4×8”
  • 6 “BRICK 2×4”

Benefits of using Video DOT

Convenience

It allows patients to take their TB medications in their own home at a time that is most convenient for them. Traditional in-person DOT requires Public Health staff to go the patient’s home at a set time 5 days a week and observe them taking their TB medications

Independence

VDOT provides patients with greater independence by allowing them to complete their treatment with less home visits from staff and while travelling.

Continuity

Inclement weather or holiday schedules can prevent Tuberculosis program staff from being able to complete DOT at someone’s home. VDOT allows our patients to continue their prescribed treatment without having a disruption in their schedule.

Flexibility

Video-based DOT allows patients to take their medications outside of the operating hours of the TB clinic staff. Recordings can be observed by TB staff the following business day giving our patients the choice of when medication dosing works best for them.

Financial Savings

Conflicts with patient work hours are common with in-person DOT. Submitting recordings can greatly reduce interruptions with our clients’ work schedules. VDOT can also provide a significant savings to Public Health personnel costs, allowing us to protect the health of the public at a lower overall cost.