Adherence to isoniazid prophylaxis in the homeless - A randomized controlled trial

被引:96
作者
Tulsky, JP
Pilote, L
Hahn, JA
Zolopa, A
Burke, M
Chesney, M
Moss, AR
机构
[1] Univ Calif San Francisco, San Francisco Gen Hosp, Posit Hlth Program, Dept Med, San Francisco, CA 94110 USA
[2] Univ Calif San Francisco, San Francisco Gen Hosp, Dept Epidemiol & Biostat, San Francisco, CA 94110 USA
[3] McGill Univ, Montreal Gen Hosp, Dept Med, Div Clin Epidemiol, Montreal, PQ H3G 1A4, Canada
[4] Stanford Univ, Dept Med, Div Infect Dis, Stanford, CA 94305 USA
[5] Univ Calif San Francisco, Dept Med, Ctr AIDS Prevent Studies, San Francisco, CA USA
关键词
D O I
10.1001/archinte.160.5.697
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: To test 2 interventions to improve adherence to isoniazid preventive therapy for tuberculosis in homeless adults. We compared (1) biweekly directly observed preventive therapy using a $5 monetary incentive and (2) biweekly directly observed preventive therapy using a peer health adviser, with (3) usual care at the tuberculosis clinic. Methods: Randomized controlled trial in tuberculosis-infected homeless adults. Outcomes were completion of 6 months of isoniazid treatment and number of months of isoniazid dispensed. Results: A total of 118 subjects were randomized to the 3 arms of the study. Completion in the monetary incentive arm was significantly better than in the peer health adviser arm (P =.01) and the usual care arm (P =.04), by log-rank test. Overall, 19 subjects (44%) in the monetary incentive arm completed preventive therapy compared with 7 (19%) in the peer health adviser arm (P =.02) and 10 (26%) in the usual care arm (P =.11). The median number of months of isoniazid dispensed was 5 in the monetary incentive arm vs 2 months in the peer health adviser arm (P =.005) and 2 months in the usual care arm (P =.04). In multivariate analysis, independent predictors of completion were being in the monetary incentive arm (odds ratio, 2.57; 95% CT, 1.11-5.94) and residence in a hotel or other stable housing at entry into the study vs residence on the street or in a shelter at entry (odds ratio, 2.33; 95% CI, 1.00-5.47). Conclusions: A $5 biweekly cash incentive improved adherence to tuberculosis preventive therapy compared with a peer intervention or usual care. Living in a hotel or apartment at the start of treatment also predicted the completion of therapy.
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页码:697 / 702
页数:6
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