Tuberculosis (TB) is a major problem in the United States, yet little is known about the efficacy of intervention studies focused on enhancing completion of TB prevention programs among PPD positive homeless men and women, many of whom are addicted to drugs and alcohol, at risk for active TB, hard to reach and difficult to treat. In this prospective two-group quasi-experimental design, we will evaluate the effectiveness of a theoretically-based preventive intervention program focused primarily on compliance with TB chemoprophylaxis treatment, and secondarily on HIV risk reduction, with 480 sheltered men and women in the high TB prevalence area of Skid Row in Los Angeles. Initially, screening for chemoprophylaxis eligibility will be conducted with 6424 sheltered homeless living in the Skid Row area with anticipated PPD testing on a sample of 2762. Subsequent to final approval for chemoprophylaxis, a sample of 600 PPD positive homeless will be randomized by shelter into one of two programs, a Nurse Case Managed Plus Incentive (NCMI) Program or a Control Program. Participants in the NCMI program will receive the intervention by trained research nurses and outreach workers at the TB Satellite Clinic weekly over eight weeks, along with biweekly Directly Observed (DOT) and incentives for six months. Control group participants will receive basic care which includes biweekly DOT visits at the TB Satellite Clinic, and incentives for six months. All participants will be assessed at baseline and six-month follow-up using a battery of psychosocial, behavioral, health and physical status measures. The Comprehensive Health Seeking and Coping Paradigm will serve as the theoretical underpinning for guiding the assessment and implementation of strategies related to health outcome in this study. The long term goals of the study are to design effective programs for sheltered homeless individuals that focus on decreasing the spread of TB directly via completion of TB preventive programs for PPD positive individuals and indirectly via reduction of risk for HIV.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA011145-03
Application #
6174970
Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Davenny, Katherine
Project Start
1998-08-01
Project End
2003-07-31
Budget Start
2000-08-01
Budget End
2001-07-31
Support Year
3
Fiscal Year
2000
Total Cost
$711,208
Indirect Cost
Name
University of California Los Angeles
Department
Type
Schools of Nursing
DUNS #
119132785
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
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Schumann, Anja; Nyamathi, Adeline; Stein, Judith A (2007) HIV risk reduction in a nurse case-managed TB and HIV intervention among homeless adults. J Health Psychol 12:833-43
Nyamathi, Adeline; Stein, Judith A; Schumann, Anja et al. (2007) Latent variable assessment of outcomes in a nurse-managed intervention to increase latent tuberculosis treatment completion in homeless adults. Health Psychol 26:68-76
Nyamathi, A M; Christiani, A; Nahid, P et al. (2006) A randomized controlled trial of two treatment programs for homeless adults with latent tuberculosis infection. Int J Tuberc Lung Dis 10:775-82
Berg, Jill; Nyamathi, Adeline; Christiani, Ashley et al. (2005) Predictors of screening results for depressive symptoms among homeless adults in Los Angeles with latent tuberculosis. Res Nurs Health 28:220-9
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Nyamathi, Adeline; Sands, Heather; Pattatucci-Aragon, Angela et al. (2004) Perception of health status by homeless US veterans. Fam Community Health 27:65-74