A randomized trial comparing standard outcomes in two treatment models for substance users with tuberculosis

被引:10
作者
Ricks, P. M. [1 ]
Hershow, R. C. [1 ]
Rahimian, A.
Huo, D. [2 ]
Johnson, W. [3 ]
Prachand, N. [4 ]
Jimenez, A. [1 ]
Wiebel, W. [1 ]
Paul, W. [5 ]
机构
[1] Univ Illinois, Sch Publ Hlth, Chicago, IL USA
[2] Univ Chicago, Dept Hlth Studies, Chicago, IL 60637 USA
[3] Georgia Perimeter Coll, Fairburn, GA USA
[4] Chicago Dept Publ Hlth, Chicago, IL USA
[5] Metro Publ Hlth Dept Nashville Davidson Cty, Nashville, TN USA
基金
美国国家卫生研究院;
关键词
compliance; adherence; hard-to-reach populations; indigenous leadership; DIRECTLY OBSERVED THERAPY; RISK; ADHERENCE;
D O I
10.5588/ijtld.14.0471
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
SETTING: Chicago Department of Public Health (CDPH), TB Control Program. OBJECTIVES: To compare anti-tuberculosis treatment outcomes using two different types of directly observed therapy (DOT) outreach workers. METHODS: Substance users diagnosed with TB from October 1996 to July 2000 were randomized to DOT administered by either 1) CDPH personnel (standard arm) or 2) previous substance-using human immunodeficiency virus/acquired immune-deficiency syndrome outreach workers (enhanced arm). Treatment completion was physician-determined, and adherence was estimated based on risk of missed DOT appointments. RESULTS: Of 94 patients, 46 were randomized to the standard and 48 to the enhanced arm. The standard arm had a significantly higher risk of non-completion of treatment (39% vs. 15%, RR 2.7, 95%CI 1.2-5.8), and a significantly higher risk of missing DOT appointments (RR 2.6, 95%CI 1.4-4.8). For both outcomes, housing instability was a significant predictor in multivariate analyses. CONCLUSIONS: TB treatment completion and adherence among substance users was improved by the enhanced intervention; the familiarity of enhanced-arm DOT workers with the patients' social norms due to their own previous substance use may have made them more effective. Successful DOT in hard-to-reach populations may require strategies that directly address the population's circumstances and utilize DOT workers who are intimately familiar with patients' life situations.
引用
收藏
页码:326 / 332
页数:7
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