Peer-Reviewed Journal Publications of emocha implementations

Holzman SB, Atre S, Sahasrabudhe T, Ambike S, Jagtap D, Sayyad Y, Kakrani AL, Gupta A, Mave V, Shah M. Use of Smartphone-Based Video Directly Observed Therapy (vDOT) in Tuberculosis Care: Single-Arm, Prospective Feasibility Study. JMIR Form Res 2019;3(3):e1341. URL:

“Median adherence was 74% (IQR 62%-84%), and median verifiable fraction was 86% (IQR 74%-98%). More than 90% of patients reported recording and uploading videos without difficulty.”

Holzman SB, Zenilman A, Shah M. Advancing Patient-Centered Care in Tuberculosis Management: A Mixed-Methods Appraisal of Video Directly Observed Therapy. OFID 2018, Volume 5, Issue 4, ofy046,

“Medication adherence on vDOT was comparable to that of in-person DOT (94% vs 98%, P = .17), with a higher percentage of total treatment doses (inclusive of weekend/holiday self-administration) ultimately observed during the vDOT period (72% vs 66%, P = .03).”

Morris S, Miner M, Rodriguez T, Stancil R, Wiltz-Beckham D, Chorba T. Notes from the Field: Tuberculosis Control Activities After Hurricane Harvey — Texas, 2017. MMWR Morb Mortal Wkly Rep 2017; 66:1362–1363.

“Sixty-one patients had already been placed on video-enabled DOT, 30 had TB disease (cases), and 31 had latent TB infection and needed DOT. Fifty-nine (97%) were monitored successfully and did not miss any medication doses.”

Olano-Soler H, Thomas D, Joglar O, et al. Notes from the Field: Use of Asynchronous Video Directly Observed Therapy for Treatment of Tuberculosis and Latent Tuberculosis Infection in a Long-Term–Care Facility ― Puerto Rico, 2016–2017. MMWR Morb Mortal Wkly Rep 2017;66:1386–1387.

“Use of asynchronous VDOT saved PRDH approximately 240 hours in DOT-related activities, equivalent to 25% of the workload for a full-time epidemiology technician/case manager over 6 months of treatment… As of July 12, 2017, all 11 patients with active TB disease and all six with LTBI had completed treatment with recommended ≥80% compliance (percentage of scheduled doses actually taken) (Table) (6).”

Hepatitis C 

Litwin AH, Jost J, Wagner K, et al. Rationale and design of a randomized pragmatic trial of patient-centered models of hepatitis C treatment for people who inject drugs: The HERO study. Contemp Clin Trials. 2019;87:105859. doi:10.1016/j.cct.2019.105859 (Protocol paper)

“This study addresses an urgent need for timely and accurate information on optimal models of care to promote HCV treatment initiation, adherence, treatment completion and SVR among PWID, as well as rates and factors associated with reinfection and resistance after treatment.”

Opioid Use Disorder

Schramm ZA, Leroux BG, Radick AC, Ventura AS, Klein JW, Samet JH, Saxon AJ, Kim TW, Tsui JI. Video directly observed therapy intervention using a mobile health application among opioid use disorder patients receiving office-based buprenorphine treatment: protocol for a pilot randomized controlled trial. Addict Sci Clin Pract. 2020 Jul 31;15(1):30. doi: 10.1186/s13722-020-00203-9. PMID: 32736660; PMCID: PMC7393902. (Protocol paper)

Godersky ME, Klein JW, Merrill JO, Blalock KL, Saxon AJ, Samet JH, Tsui JI. Acceptability and Feasibility of a Mobile Health Application for Video Directly Observed Therapy of Buprenorphine for Opioid Use Disorders in an Office-based Setting. J Addict Med. 2020 Jul/Aug;14(4):319-325. doi: 10.1097/ADM.0000000000000608. PMID: 31972762; PMCID: PMC7358111.

Godersky ME, Saxon AJ, Merrill JO, Samet JH, Simoni JM and Tsui JI. Provider and patient perspectives on barriers to buprenorphine adherence and the acceptability of video directly observed therapy to enhance adherence. Addict Sci Clin Pract 2019; 14:11.

Peer-Reviewed Posters or Presentations of emocha implementations

Hepatitis C
Kiser, Jennifer J.; Brooks, Kristina M.; Castillo-Mancill, Jose R.; Morrow, Mary; MaWhinney, Samantha; Rowan, Sarah E.,; Blum, Joshua; Wyles, David L.; Huntley, Ryan T.; Salah, Lana M.; Tehrani, Arya; Roon, Laura; Bushman, Lane R.; Anderson, Peter L. (2020, March). Adherence in Active Drug Users with HCV: The INCLUD Trial. Poster session presented at the Conference on Retroviruses and Opportunistic Infections (CROI).

emocha’s summary of findings: In a study to define the degree of direct acting antiviral agent (DAA) medication adherence needed for cure of Hepatitis C (HCV) infection among drug users, two methods of modified Directly Observed Therapy were compared (video DOT using the emocha mobile app vs. wireless pillboxes) (INCLUD Trial, NCT02573376). Assignment to video-based DOT was associated with higher odds of 100% adherence to treatment compared to wireless pillboxes (OR = 2.20, 95% CI, 1.07,4.53; p<0.03). Sustained virologic response at 12 weeks (SVR12) of treatment was higher among participants assigned to video DOT compared to those given pillboxes (ITT: 90% vs 84%, PP: 96% vs. 93%). SVR12 was sufficiently high in both groups to suggest a high potential for cure even among patients who may struggle to achieve perfect adherence. Findings suggest that while facilitating high adherence with behavioral tools and methods like video DOT remains important, high rates of cure may be possible with broad expansion HCV treatment programs for active drug users.


Henderson, Macey; Saha, Amrita; Langlee, Julie; Lees, Laura; Helfer, David; Waldram, Madeleine; Love, Arthur; Rivera, Francisco; Massie, Allan; Segev, Dorry; Brennan, Daniel. Personalized Mobile Medication Adherence Monitoring: A Pilot Randomized Control Trial of mDOT for Transplantation. Poster session presented at the American Society for Transplantation: Transplant Summit 2019, Phoenix, Arizona. 


Perez, Hector; Cervantes, Joaquin; Barrera, G.; Campos, A.; Assael, R. (2018, May). Patient-Centered Monitoring for TB Treatment Adherence in a Large Mexican Health Jurisdiction. Poster session presented at the National Tuberculosis Conference, Palm Springs, Ca.

Prado, Joe. (2018, May). Use of Asynchronous Video Directly Observed Therapy to Improve the Patient Treatment Experience and Reduce Greenhouse Emissions. Poster session presented at the meeting of the National Tuberculosis Controllers Association, Palm Springs, CA. 

O’Mallan, Josephine; Mbakwem, Chima; Florig, Jenette; Camacho, Larissa. (2019, April). Mobile Technology Innovation in the US Pacific Islands: Guam’s Use of Asynchronous Video Directly Observed Therapy for Tuberculosis. Poster session presented at the National Tuberculosis Conference, Atlanta, Ga.

Sanders, Genevieve; Scott, Mary; Rios-Benitez, Hevert; Fields, Kimberly; Cruz, Merci; Becker, Les; Shah, Umair. (2019, April). Initiation of Targeted Testing Using VDOT. Poster session presented at the National Tuberculosis Conference, Atlanta, Ga.

Rubinstein, Rebecca; Siddiqui, Sarah; Wiltz-Beckham, Dana; FIelds, Kimberly; Sakhon, Vishaldeep; Reed, Brian C.; Pennel, Cara; Kaul, Sapna; Becker, Les; Shah, Umair A. (2018, May). Costs Saved Using Video DIrectly Observed Therapy on Tuberculosis Patients. Poster session presented at the meeting of the National Tuberculosis Controllers Association, Palm Springs, CA. 

Medrano, Alexis; Sekhon, Vishaldeep; Wiltz-Beckham, Dana; Fields, Kimberly; LaRue, Jennifer; Carrera, Denise; Scott, Mary; Reed, Brian; Becker, Les; Shah, Umair A. (2018, May). Video Directly Observed Therapy (VDOT) — A Useful Approach to Tuberculosis (TB) Treatment in a Natural Disaster. Poster session presented at the meeting of the National Tuberculosis Controllers Association, Palm Springs, CA. 

Helfrich, Cherie; Freeman, Dorothy; Baruch, Nancy; Rios, Katrina. (2019, April). Utilizing Data to Establish an Evidence-based Statewide Asynchronous Video Directly Observed Therapy Program. Poster session presented at the National Tuberculosis Conference, Atlanta, Ga.

Chapman, S; Holzman, S; Rios, KC; Shah, M. (2017, March). Implementing Mobile Health for Tuberculosis Care in Sydney: Experience with Video Directly Observed Therapy. Poster session presented at the Australasian Society for Infectious Diseases 2017 Annual Scientific Meeting, Leura, NSW, Australia. 

Browning, Carol A.; Bertrand, Thomas; Marak, Theodore, P.; Rybak, Natasha. (2018, May). An Evaluation of the Use of Live and Asynchronous Video Technology for Directly Observed Therapy (DOT) for the Treatment of Tuberculosis (TB) in Rhode Island. Poster session presented at the meeting of the National Tuberculosis Controllers Association, Palm Springs, CA. 

Opioid Use Disorder

Tsui, Judith I.; Godersky, Margo E.; Merrill, Joseph O.; Samet, Jeffrey H. (2018, April). Perspectives on Buprenorphine Adherence and Use of mHealth Technology to Address Barriers. Poster session presented at the American Society of Addiction Medicine Annual Conference: Innovations in Addiction Medicine and Science, San Diego, CA.