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Telemedicine-assisted Directly Observed Therapy (DOTS) for Tuberculosis: An Evidence-based Case Report
Valerie Josephine Dirjayanto1, Kieran Pasha Ivan Sini2, Aureilia Calista Zahra3
1Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.. vjosephine8@gmail.com.
Acta Medica Indonesiana
|October 6, 2025
Summary
Telemedicine-based directly observed therapy (DOTS) shows promise for improving tuberculosis treatment compliance, completion, and cure rates. While effective, further research is needed for resource-limited settings.
Area of Science:
- Public Health
- Infectious Diseases
- Digital Health
Background:
- Tuberculosis (TB) is a significant global health challenge requiring sustained treatment adherence.
- Directly Observed Therapy (DOTS) is effective but faces accessibility limitations.
- Telemedicine offers a potential solution to enhance DOTS accessibility and patient compliance.
Purpose of the Study:
- To evaluate the effectiveness of telemedicine-based DOTS in improving treatment compliance among tuberculosis patients.
- To synthesize evidence from systematic reviews on various telemedicine modalities for TB treatment.
Main Methods:
- A comprehensive literature search was conducted across major databases (MEDLINE, Scopus, EMBASE, PubMed, Cochrane) up to November 2023.
- Included studies were systematically appraised for validity and applicability using the Oxford Centre for Evidence-Based Medicine tool.
- Outcomes were graded based on their Levels of Evidence (LOE).
Main Results:
- Telemedicine-DOTS demonstrated favorable effects on adherence (LOE: I), treatment completion (LOE: II-III), and cure rates (LOE: II-III).
- Bacteriological resolution (LOE: II) and mortality (LOE: IV) were found to be non-inferior compared to traditional DOTS.
- Video-DOTS showed the highest LOE for improving adherence (LOE: I), followed by SMS and medication monitors (LOE: III).
Conclusions:
- Telemedicine-DOTS is a viable strategy to enhance TB treatment adherence, completion, and cure rates.
- It appears non-inferior to conventional DOTS regarding key clinical outcomes.
- Further high-quality research, particularly in resource-limited settings, is recommended to solidify evidence.
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