From a Distance, Nurses Can Make Sure Sufferers Stay on the Long Road to a Cure for Tuberculosis

Patients must take a minimum of six months' worth of medicine for TB, often with side effects that include deep fatigue, nausea, itching and rashes. And many patients begin to feel much better only a few months into treatment, prompting some to stop taking their medicine early. TB treatment has evolved to face both of these dilemmas.

The gold standard for treatment is having someone, often a nurse, watch TB patients take every single dose. Time-consuming, expensive and tough on the patient's schedule, the regimen guarantees support and compliance. But a group of Pierce County, Wash., doctors in an infectious diseases practice decided there is even a better way. Using a videophone, the directed therapy still uses nurses but allows them to watch patients from afar and schedule treatment times more convenient for the patients.

The program is the first of its kind in the United States and is receiving national attention because it appears to boost cure rates and cut costs. The doctors who developed the program say that it also may work with patients who have HIV or AIDS. "It's an excellent model," said Diann Sharma, a senior epidemiologist with the Tacoma-Pierce County Health Department. "We would really encourage other communities to take a look at this." The videophones cost only a few hundred dollars each and the Health Department picks up the tab. Patients need only a phone line and a TV set.

The Johns Hopkins University AIDS-HIV report recently called the program "one of the more creative [directly observed therapy] initiatives." According to an article to be published in January in Clinical Infectious Care, investigator DeMaio and his co-authors reported that during the 304 treatment doses of TB medicine, adherence to a videophone program was 95 percent, and patient acceptance of the technology was excellent.

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