Since 1985, there has been a resurgence of tuberculosis in the United States. Long Beach, California has a case rate approximately 2.5 times the national average. The increase in TB has been concentrated in several high risk groups. Minority demographic groups appear to be more likely to be infected due to one of several reasons including recent immigration, HIV infection, and adverse social and economic circumstances including substance abuse, substandard and crowded housing, or homelessness. Although the prevalence of TB infection among community samples of injection drug users (IDUs) is not clearly known, it appears to be significantly higher than the rest of the population. Because of the relatively high risk of latent TB infection among IDUs and their high risk for HIV infection, the Advisory Committee for the Elimination of Tuberculosis has recommended preventive therapy for all IDUs with a positive TB skin test (and no evidence of active disease) regardless of age. Compliance with both screening and treatment are likely to be difficult to achieve among IDUs living in the community, and approaches to increasing compliance in this population have not been systematically studied.
One aim of the proposed study is to determine the prevalence of TB infection within a community-based sample of IDUs in the greater Long Beach area of southern California. In addition, approaches to increasing return rates for tuberculosis (TB) skin test reading, and compliance with preventive TB therapy will be systematically explored in this study. A total of 2,000 IDUs will be screened for TB over a three year period. Two-thirds of these subjects will have recently completed participation in a NIDA community demonstration project. The remaining one-third will be recruited from the surrounding community using identical eligibility criteria. After stratifying subjects by participation/nonparticipation in the NIDA community demonstration study, subjects will be randomly assigned to one of six study arms. A theory- based motivational educational intervention and different levels of monetary incentives will be evaluated in terms of their effectiveness in motivating return for skin-test reading. The primary outcome measure for this part of the study will be the percentage of subjects in each group who return for skin test reading at their scheduled appointment without additional outreach efforts. All skin test readings will be conducted within two to five days. A coordinated system of advocacy and referral for skin-test positive individuals to facilitate priority evaluation and determination of appropriate treatment protocols will be implemented. Persons who are found to be infected with TB will be treated for active disease or placed on INH preventive therapy, as appropriate. All subjects who are eligible for INH and agree to further study participation will be placed on twice weekly directly observed therapy. The effectiveness of incentives versus active outreach in increasing the completion rate for subjects who are placed on preventive therapy will be examined.
| Malotte, C K; Hollingshead, J R; Larro, M (2001) Incentives vs outreach workers for latent tuberculosis treatment in drug users. Am J Prev Med 20:103-7 |
| Malotte, C K; Hollingshead, J R; Rhodes, F (1999) Monetary versus nonmonetary incentives for TB skin test reading among drug users. Am J Prev Med 16:182-8 |
| Malotte, C K; Rhodes, F; Mais, K E (1998) Tuberculosis screening and compliance with return for skin test reading among active drug users. Am J Public Health 88:792-6 |
