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Harris County Public Health Environmental Services TB Elimination Program

In 2014, Texas ranked 4th in the nation in TB disease burden, with 1,269 cases of active TB (case rate 4.7 per 100,000 population). TB is a disease of even greater concern in Harris County, Texas, where the case rate is roughly 60% higher than the Texas rate. TB rates are disproportionately high in underserved and vulnerable persons such as low income, uninsured, homeless, refugee, and immigrant populations – all of which are present within Harris County.

In 2014, the Harris County Public Health Environmental Services (HCPHES) TB Elimination Program treated 125 patients with active TB. HCPHES provided directly observed therapy (DOT) to all cases, including one with Multidrug-Resistant Tuberculosis, and 38 others who were initially suspected to have TB disease. The same year, HCPHES implemented Video Directly Observed Therapy (VDOT) for TB treatment. This smartphone-based technology allows patients to remotely record daily medication doses, replacing traditional DOT home visits. As of February 2016, Harris County has placed 115 patients onto its VDOT program. VDOT has transformed TB care in Harris County. It enhances patient privacy and autonomy, and augments regimen adherence. VDOT has also reduced health department transportation costs, and improved worker safety.

HCPHES has published a detailed VDOT Implementation Guide that may be utilized by other health departments interested in VDOT. Through maximizing efficient use of resources, HCPHES has found VDOT to be a cost-effective technology which enhances patient-centered care, improves regimen completion, and decreases TB transmission rates.