VOT - Video Supported Treatment


There are two main categories of VOT: synchronous and asynchronous[1]. Synchronous VOT makes use of a real-time video conference connection between the patient and the health care provider that allows the health care provider to observe medication intake remotely at the time the medications are taken. Asynchronous VOT utilizes video recording and mobile communication to allow patients to record their medication ingestion, which the health care provider can watch upon receiving the video. Using an asynchronous video approach, patients are guided to record videos of themselves ingesting their daily medication, which are uploaded to a secure remote server that can be accessed by the health care provider to observe the doses taken either immediately upon arrival or at the earliest opportunity. While most other DATs rely more on the technology as a proxy for daily dosing, VOT is the closest approach to “remote” Direct Observed Treatment (DOT). VOT is suited for DS-TB, DR-TB and LTBI patients and facilitates remote medication monitoring and patient support. The use of VOT will depend on the availability of certain technology requirement such as smartphones or tablet computers, mobile connectivity infrastructure, and technology literacy.


After reading this section, you should be able to:

  • Describe the features of functionalities of VOT

  • Describe the VOT products in the market and the companies that support them

  • Understand the the available research evidence on VOT

  • Understand the learning from country implementations of VOT



Figure 1: Sample Video from VOT application viewed by a HCW


VOT Example

There are several types of VOTs, with diverse features, currently on the market which are used extensively in countries. Rigorous research using a prototype VOT platform developed in 2010 by the University of California San Diego and implemented through health departments in the U.S. and Mexico provided the foundation for SureAdhere to bring VOT to the global market. Since 2015 continued learning from TB Control Programs and their patients while using VOT in practice to translate that unique knowledge into a powerful, user-friendly, client-centered product. SureAdhere’s application has subsequently been implemented in 17 states across the U.S., Mexico, the United Kingdom, Vietnam, Uganda, the Philippines, Haiti, Ukraine, and Kyrgyzstan, and is referred to in the WHO Handbook for the use of digital technologies to support TB medication adherence.

SureAdhere [2] is a San Diego-based company and provides a mobile health platform that enables remote medication adherence monitoring through video technology for patients with TB and other diseases. The platform was established through National Institutes of Health-funded research. SureAdhere’s VOT has been evaluated across the U.S., and in Mexico, the United Kingdom, and Vietnam. In September 2018, SureAdhere announced a partnership with Everwell Health Solutions and has integrated its asynchronous VOT app into the Everwell Hub to allow NTPs the ability to use multiple DAT strategies within a single platform.[3].

Figure 2: How to use the VOT application

Examples of country implementations in LMIC’s


Country / Region

Patient Target






Country / Region

Patient Target








PATH, KNCV, LHSI, NTP of Ukraine

TB REACH (Stop TB Partnership)

Demonstration of video observed treatment to assist patients in treatment adherence in Odeska and Mykolaivska oblasts


Aleksey Bogdanov abogdan@path.org



MDR-TB (650) Males and females aged ≥13 years

De La Salle Health Sciences Institute, Cavite, NTP of Philippines

TB REACH (Stop TB Partnership)

VOT Feasibility and Acceptability in 6 PMDT Clinic Sites (DLSHSI, GEAMH, Bacoor, Imus and Tagaytay

Duration: 18 months from Quarter 4, 2018

Maria Tarcela Gler




DS-TB (516) and DR-TB (134)

Center for Health Policies and Studies (PAS Center), NTP of Moldova

TB REACH (Stop TB Partnership)

People centered TB care in Moldova: Scaling up digital treatment adherence approach in 14 health facilities


Cristina Celan





Red Crescent Society Kyrgyzstan, NTP of Kyrgyzstan

TB REACH (Stop TB Partnership)

To simultaneously pilot 3 Project Models in Bishkek city (4 districts) and Chui region (5 districts)

(a)“Traditional” model, (b) Combination of “traditional” and usage of Electronic Dose Monitors and (c) Combination of “traditional” and usage of Video Observed Treatment.




DR-TB (RR-TB) - 579 patients; DS-TB - 414 patients

NTP of Belarus

Global Fund to Fight AIDS, Tuberculosis and Malaria

Providing VOT at the outpatient stage of treatment for patients throughout the country (6 regions and the Minsk city). Smartphones are provided to patients free, cost of Internet services are covered. It is possible to install software on personal smartphones of patients. Sustainability guarantee - placing the server part of the application on the servers of a state organization (oversees digital healthcare).

Alena Skrahina alena.skrahina@gmail.com

Challenges Experienced in Countries during Implementation:

  • Poor internet connectivity causing slow video download;

  • Available data storage on device needed to record videos;

  • Patient training needs for phone and app use vary;

  • More time required by HCWs to view video recordings compared to no DOT;

  • Approval of use of VOT in country guidelines;

  • Country legislation with regards to patient data security.

Lessons Learned by Countries during Implementation:

  • Collaboration with the NTP supported the institutionalization of the VOT;

  • Customized training packages for users.

Figure 3: Generic VOT flow diagram in Philippines

Figure 4: VOT in use and dashboard in Philippines

Figure 5: VOT App showing coverage in Moldova


Figure 5: Video recording set up by patient in Moldova



Figure 6: Integration of the VOT app on the Everwell hub in Kyrgyzstan


Tools and resources