“When choosing the subject for my M.D./M.P.H. practicum, I sought to connect the material I was learning in my clinical education to real-world public health interventions happening in the community around me,” said Raj. Inspired by a lecture from Dr. David Ashkin, Florida's Medical Director for TB, Raj saw an opportunity to address gaps in TB care through advanced technology, joining Dr. Ashkin's research team to further explore these possibilities.

Raj’s study, “Investigating the Efficacy of Integrating Video-Directly Observed Therapy (VDOT) in the Treatment of Tuberculosis (TB): A Statewide Analysis from Florida,” was published in the Journal of Clinical Tuberculosis and Other Mycobacterial Diseases This large-scale, state-wide study represents the first of its kind to evaluate Florida Department of Health data from over 1,300 TB patients treated between 2018 and 2021. The research compared traditional directly observed therapy (DOT)—where healthcare workers supervise in-person medication intake—with the virtual VDOT method, which uses telehealth to remotely monitor patients' adherence to treatment.

Analyzing the complex and comprehensive dataset presented challenges. 

The study included multiple variables such as patient demographics, geographical locations, and adherence records from both DOT and VDOT patients. “Ensuring data accuracy across such a broad population required a meticulous approach,” Raj explained. Her team employed advanced statistical models to assess whether VDOT was a non-inferior alternative to traditional therapy.

The research faced significant challenges, particularly in ensuring data accuracy across such a large cohort. “There was a substantial effort involved in manually tracking down missing data and verifying records,” Raj explained. Despite these challenges, the study stands as a testament to rigorous public health research that bridges clinical practice and community healthcare interventions. 

Results revealed that VDOT produced superior outcomes compared to DOT. 

“Our work revealed that the integration of VDOT demonstrated statistically significant improvements in both TB therapy completion and duration of TB therapy outcomes compared to directly observed therapy alone,” Raj explained. 

Patients using VDOT reported improved completion rates and shorter durations of therapy, offering them greater flexibility in managing their treatment. “VDOT allows for increased autonomy in addition to reduced perceptions of stigma and fewer logistical barriers to care coordination,” said Raj. These findings are particularly significant in the broader context of public health, as VDOT offers a cost-effective, non-inferior alternative to DOT, potentially reducing healthcare costs for community health departments. 

The study also illuminated key insights into the impact of the COVID-19 pandemic on telehealth adoption. While the global uptake of telehealth services increased dramatically during the pandemic, Raj’s team found that VDOT’s adoption was slower than anticipated. "We were surprised by the limited uptake of VDOT during the pandemic despite the widespread shift toward telemedicine,” Raj noted. This finding suggests ongoing barriers to technology access, particularly among underserved populations, and highlights areas for future intervention.

Looking ahead, Raj plans to continue building on this research through her M.D./M.P.H. Capstone Project, which will examine the qualitative factors influencing uptake. “I am hoping that further investigations will highlight existing barriers to this form of care in an effort to improve equitable access to VDOT,” she said. Her future work aims to gather insights from both health departments and patients to improve the delivery of TB care, particularly in underserved communities.

For Raj, this research emphasizes the importance of keeping health equity at the forefront of her future career as a physician. Reflecting on this experience, Raj said, “It was incredibly rewarding to lead this investigation from start to finish and I am grateful for the opportunity to demonstrate the success of a public health intervention that is improving the quality and accessibility of healthcare for many patients.”

Written by Deycha Torres Hernández, published on August 26, 2024.