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Journal of Urban Health

, Volume 80, Issue 3, pp 428–437 | Cite as

Impact of monetary incentives on adherence to referral for screening chest X-rays after syringe exchange-based tuberculin skin testing

  • David C. PerlmanEmail author
  • Patricia Friedmann
  • Leslie Horn
  • Anne Nugent
  • Veronika Schoeb
  • Jeanne Carey
  • Nadim Salomon
  • Don C. Des Jarlais
Original Articles: Various Topics

Abstract

Introduction

Syringe-exchange programs (SEPs) have proven to be valuable sites to conduct tuberculin skin testing among active injection drug users. Chest x-rays (CXRs) are needed to exclude active tuberculosis prior to initiating treatment for latent tuberculosis infection. Adherence of drug users to referral for off-site chest x-rays has been incomplete. Previous cost modeling demonstrated that a monetary incentive to promote adherence could be justified on the cost basis if it had even a modest effect on adherence.

Methods

We compared adberence to referral for chest x-rays among injection drug users undergoing syringe exchange-based tuberculosis screening in New York City before and after the implementation of monetary incentives.

Results

From 1995 to 1998, there were 119 IDUs referred for CXRs based on tuberculin skin testing at the SEP. From 1999 to 2001, there were 58 IDUs referred for CXRs with a S25 incentive based on adherence. Adherence to CXR referral within 7 days was 46/58 (79%) among individuals who received the monetary incentive versus 17/119 (14%) prior to the implementation of the monetary incentive (P<.0001; odds ratio [OR]=23; 95% confidence interval [CI]=9.5-5.7). The median time to obtaining a CXR was significantly shorter among those given the incentive than among those referred without the incentive (2 vs. 11 days, P<.0001). In multivariate logistic regression analysis, use of the incentive was highly independently associated with increased adherence (OR=22.9;95% CI=10–52).

Conclusions

Monetary incentives are highly effective in increasing adherence to referral for screening CXRs to exclude active tuberculosis after syringe exchangebased tuberculin skin testing. Prior cost modeling demonstrated that monetary incentives could be justified on the cost basis if they had even a modest effect on adherence. The current data demonstrated that monetary incentives are highly effective at increasing adherence in this setting and therefore are justifiable on a cost basis. When heath care interventions for drug users require referral off site, monetary incentives may be particularly valuable in promoting adherence.

Keywords

Adherence Drug users Incentives Tuberculosis 

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References

  1. 1.
    Reichman LB, Felton CP, Edsall JR. Drug dependence, a possible new risk factor for tuberculosis disease. Arch Intern Med. 1979;139:337–339.CrossRefPubMedGoogle Scholar
  2. 2.
    Friedman LN, Sullivan GM, Bevilaqua RP, Loscos R. Tuberculosis screening in alcoholics and drug addicts. Am Rev Respir Dis. 1987;136:1188–1192.PubMedGoogle Scholar
  3. 3.
    Perlman DC, Salomon N, Perkins MP, Yancovitz S, Paone D, Des Jarlais DC. Tuberculosis in drug users. Clin Infect Dis. 1995;21:1253–1264.PubMedGoogle Scholar
  4. 4.
    National Consensus Development Panel on Effective Treatment of Opiate Addiction. Effective medical treatment of opiate addiction. JAMA. 1998;280:1936–1943.CrossRefGoogle Scholar
  5. 5.
    Perlman DC, Perkins MP, Salomon N, Kochems L, Des Jarlais DC, Paone D. Tuberculosis screening at a syringe exchange program. Am J Public Heath. 1997;87:862–863.Google Scholar
  6. 6.
    Fitzgerald JM, Patrick DM, Strathdee S, et al. Use of incentives to increase compliance for TB screening in a population of intravenous drug users. Vancouver Injection Drug Users Study Group. Int J Tuberc Lung Dis. 1999;3:153–155.PubMedGoogle Scholar
  7. 7.
    Riley ED, Vlahov D, Huettner S, Beilenson P, Bonds M, Chaisson RE. Characteristics of injection drug users who utilize tuberculosis services at sites of the Baltimore city needle exchange program. J Urban Health. 2002;79:113–127.PubMedGoogle Scholar
  8. 8.
    Centers for Disease Control and Prevention update: syringe exchange programs—United States, 1998. MMWR Morb Mortal Wkly Rep. 2001;50:384–387.Google Scholar
  9. 9.
    Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR Morb Mortal Wkly Rep. 2000;249(RR-6):1–51.Google Scholar
  10. 10.
    Sbarbaro JA. To seek, find, and yet fail. Am Rev Respir Dis. 1987;136:1072–1073.PubMedGoogle Scholar
  11. 11.
    Perlman DC, Gourevitch MN, Trinh C, Salomon N, Horn L, Des Jarlais DC. Cost-effectiveness of tuberculosis screening and observed preventive therapy for active drug injectors at a syringe-exchange program. J Urban Health. 2001;78:550–567.PubMedGoogle Scholar
  12. 12.
    Salomon N, Perlman DC, Friedmann P, Ziluck V, Des Jarlais DC. Prevalence and risk factors for positive tuberculin skin tests among active drug users at a syringe exchange program. Int J Tuberc Lung Dis. 2000;4:47–54.PubMedGoogle Scholar
  13. 13.
    Umbricht-Schneiter A, Ginn DH, Pabst KM, Bigelow GE. Providing medical care to methadone patients: referral versus on-site care. Am J Public Health. 1994;84:207–210.PubMedCrossRefGoogle Scholar
  14. 14.
    Batki SL, Gruber VA, Bradley JM, Bradley M, Delucchi K. A controlled trial of methadone treatment combined with directly observed isoniazid for tuberculosis prevention in injection drug users. Drug Alcohol Depend. 2002;66:283–293.CrossRefPubMedGoogle Scholar
  15. 15.
    Trubatch BN, Fisher DG, Cagle HH, Fenaughty AM. Vaccination strategies for targeted and difficult-to-access groups. Am J Public Health. 2000;90:447.PubMedCrossRefGoogle Scholar
  16. 16.
    Des Jarlais DC, Fisher D, Clark J, et al. Providing HBV vaccination to injecting drug users: referral to health clinics and on-site at a syringe exchange program. Am J Public Health. 2001;91:1791–1792.PubMedCrossRefGoogle Scholar
  17. 17.
    Gourevitch M, Alcabes P, Wasserman WC, Arno PS. Cost-effectiveness of directly observed chemoprophylaxis among drug users at risk for tuberculosis. Int J Tuberc Lung Dis. 1998;2:531–540.PubMedGoogle Scholar
  18. 18.
    Lorvick J, Thompson S, Edlin BR, Kral AH, Lifson AR, Watters JK. Incentives and accessibility: a pilot study to promote adherence to TB prophylaxis in a high-risk community. J Urban Health. 1999;76:461–467.CrossRefPubMedGoogle Scholar
  19. 19.
    Malotte CK, Rhodes F, Mais KE. Tuberculosis screening and compliance with return for skin test reading among active drug users. Am J Public Health. 1998;88:792–796.PubMedCrossRefGoogle Scholar
  20. 20.
    Chaisson RE, Keruly JC, McAvinue S, Gallant JE, Moore RD. Effects of an incentive and education program on return rates for PPD test reading in patients with HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;11:455–459.PubMedGoogle Scholar
  21. 21.
    Faden RR, Beauchamp TL. A History and Theory of Informed Consent. New York, NY: Oxford University Press; 1986.Google Scholar
  22. 22.
    Deren S, Stephens R, Davis WR, Feucht TE, Tortu S. The impact of providing incentives for attendance at AIDS prevention sessions Public Health Rep. 1994;109:548–554.PubMedGoogle Scholar
  23. 23.
    Tashler CL, Bartholomae S. The recruitment of normal healthy volunteers: a review of the literature on the use of financial incentives. J Clin Pharmacol. 2002;42:365–375.CrossRefGoogle Scholar
  24. 24.
    Lorvick J, Edlin BR. Effectiveness of incentives in health interventions: what do we know from the literature? Paper presented at: 128th Annual Meeting of the American Public Health Association; Session 6014.0; November 16, 2000. Available at: http://apha/confex.com/apha/128am/techprogram/session_19.55.htm. Accessed June 16, 2003.Google Scholar

Copyright information

© The New York Academy of Medicine 2003

Authors and Affiliations

  • David C. Perlman
    • 1
    • 2
    Email author
  • Patricia Friedmann
    • 2
  • Leslie Horn
    • 1
  • Anne Nugent
    • 2
  • Veronika Schoeb
    • 1
  • Jeanne Carey
    • 1
  • Nadim Salomon
    • 1
  • Don C. Des Jarlais
    • 2
  1. 1.Department of MedicineBeth Israel Medical CenterNew York
  2. 2.Baron Edmond de Rothschild Chemical Dependency InstituteBeth Israel Medical CenterNew York

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