Video Directly Observed Therapy for Tuberculosis Treatment in Haitian Prisons: A Pattern of Group Adherence

Research paper.

Haitian provincial prisons historically were strapped to provide directly observed therapy (DOT) for persons with TB (PwTB) due to healthcare understaffing. A non-governmental organization addressed this gap via correctional officer-administered video DOT (VDOT).

A 16-month, quasi-experimental trial of officer-facilitated VDOT started in March 2019 at four prisons. Officers delivered doses directly without video when VDOT was inaccessible. Healthcare staff remotely tracked VDOT adherence asynchronously. Three fully-staffed prisons were controls. Our primary objective was to measure VDOT effectiveness for PwTB who began VDOT within 2 weeks of starting treatment. Our secondary objective was to measure program reach, implementation and maintenance through July 2023.

Reach-55 PwTB on VDOT met study criteria. Effectiveness: median/mean VDOT adherence for 55 individuals enrolled in the pilot were 70.8% and 60.2% respectively. Median/mean total adherence, including doses delivered by officers, were 100% and 93.5%. Implementation: VDOT adherence varied by site but not demographic characteristics; similarity of adherence patterns between subjects within a facility was high. Nursing staff reported that adherence in controls was 100%. Correctional officers reported high comfort with the program technology. Maintenance: Since the pilot, 387 PwTB have received TB medications via VDOT in the Haitian prison system.

VDOT for PwTB in low-resource Haitian prisons enabled close monitoring and follow-up; it could expand treatment options elsewhere. Total adherence neared that in control prisons. VDOT adherence varied by treatment day predominately in a group pattern, reflecting facility-level, rather than individual-level, factors.