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Free Content Can the poor adhere? Incentives for adherence to TB prevention in homeless adults

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SETTING: Community-based population of homeless adults living in San Francisco, California.

OBJECTIVE: To compare the effect of cash and non-cash incentives on 1) adherence to treatment for latent tuberculosis infection, and 2) length of time needed to look for participants who missed their dose of medications.

DESIGN: Prospective, randomized clinical trial comparing a $5 cash or a $5 non-cash incentive. All participants received directly observed preventive therapy and standardized follow-up per a predetermined protocol. Completion rates and amount of time needed to follow up participants was measured.

RESULTS: Of the 119 participants, 102 (86%) completed therapy. There was no difference between the cash and non-cash arms. Completion was significantly higher among males (OR 5.65, 95%CI 1.36–23.40, P = 0.02) and persons in stable housing at study entry (OR 4.86, 95%CI 1.32–17.94, P = 0.02). No substance use or mental health measures were associated with completion. Participants in the cash arm needed significantly less follow-up to complete therapy compared to the non-cash arm (P = 0.03). In multivariate analysis, non-cash incentive, use of crack cocaine, and no prior preventive therapy were associated with more follow-up time.

CONCLUSION: Simple, low cost incentives can be used to improve adherence to TB preventive therapy in indigent adults.

Keywords: homeless; incentives; latent tuberculosis infection; randomized trial

Document Type: Regular Paper

Affiliations: 1: Department of Medicine, Positive Health Program, University of California, San Francisco, San Francisco, California, USA 2: Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, USA 3: Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA 4: Alcohol Research Group, Public Health Institute, Berkeley, California, USA

Publication date: 2004-01-01

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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