The 4 R regimen is given as SAT. The 3HP regimen was originally studied as DOPT. While all regimens can be given as SAT, DOT may be useful in short regimens, since each dose becomes that much more important. A study looking at 3HP SAT versus DOT resulted in fewer people completing 3HP in the SAT group compared to the DOT group across all sites and countries; in the prespecified subgroup of American study sites, DOT was noninferior to SAT. Using virtual approaches for DOT may reduce the time and resources required to carry it out. Although the relative benefit of virtual (synchronous or asynchronous) vs in-person DOT has not definitively been established, small observational studies suggest favorable rates of treatment completion when administering 3HP with virtual DOT compared to SAT.80,81 Potential advantages and disadvantages of DOT are listed in Table 2.
Table 2. Potential advantages and disadvantages of providing latent tuberculosis infection treatment as directly-observed therapy (DOT).
|Potential advantages of DOT||Potential disadvantages of DOT|
|Allows for patients to ask questions to providers with each dose||Requires substantial additional healthcare worker time|
|Allows providers more frequent opportunities to detect potential adverse effects and to detect them earlier, which may enhance safety||Less convenient for patients|
|Increases treatment completion rates||Less flexibility in timing of doses|
|Ensures treatment is going according to plan, including that bloodwork and follow-up visits are arranged and attended||Patients may perceive DOT as an infringement on their autonomy|
|Allows the team to offer incentives and enablers when barriers are identified, so that patients can better adhere to the treatment|
|Allows for an opportunity for the healthcare team to identify others who might need testing in the patient’s environment|
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