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Incentives and accessibility: A pilot study to promote adherence to TB prophylaxis in a high-risk community

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Abstract

Setting

A community-based directly observed preventive therapy (DOPT) program for treatment of latent tuberculosis infection among injection drug users (IDUs) in an innercity neighborhood.

Objective

To test adherence to a 6-month course of DOPT using cash incentives and an easily accessible neighborhood location.

Design

Street-recruited IDUs (N=205) were screened forMycobacterium tuberculosis (TB) infection using the Mantoux test and two controls. Subjects who had a purified protein derivative (PPD) reaction of ≥5 mm, were anergic, or had a history of a positive PPD received clinical evaluation at a community field site, provided in collaboration with the San Francisco Department of Public Health Tuberculosis Clinic. Twenty-eight subjects were considered appropriate candidates for prophylaxis with isoniazid, and 27 enrolled in the pilot study. Participants received twice-weekly DOPT at a community satellite office, with a $10 cash incentive at each visit.

Results

The 6-month (26-week) regimen was completed by 24/27 (89%) participants. The median time to treatment completion was 27 weeks (range 26 to 34 weeks). The median proportion of dosing days attended in 6 months was 96%.

Conclusion

Community-based DOPT using cash incentives resulted in high levels of adherence and treatment completion among drug users.

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Author information

Authors and Affiliations

  1. Urban Health Study, University of California, Box 1304, 94143-1304, San Francisco, CA

    Jennifer Lorvick BA,  Suzanne Thompson BA,  Brian R. Edlin MD,  Alex H. Kral MS &  Alan R. Lifson MD, MPH

  2. Acute Disease Prevention Services, Minnesota Department of Health, Minneapolis, MN

    John K. Watters PhD

Authors
  1. Jennifer Lorvick BA
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  2. Suzanne Thompson BA
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  3. Brian R. Edlin MD
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  4. Alex H. Kral MS
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  5. Alan R. Lifson MD, MPH
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  6. John K. Watters PhD
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Corresponding author

Correspondence to Jennifer Lorvick BA.

Additional information

the late Dr. Watters was with the Urban Health Study.

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Lorvick, J., Thompson, S., Edlin, B.R. et al. Incentives and accessibility: A pilot study to promote adherence to TB prophylaxis in a high-risk community. J Urban Health 76, 461–467 (1999). https://doi.org/10.1007/BF02351503

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