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Free Content A randomized controlled trial of two treatment programs for homeless adults with latent tuberculosis infection

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SETTING: Few studies have examined strategies for optimizing adherence to latent tuberculosis infection (LTBI) treatment programs in homeless populations.

OBJECTIVES: 1) To compare the effectiveness of an intervention program employing nurse case management and incentives (NCMI) vs. a control program with standard care and incentives on completion of LTBI treatment; and 2) to compare the impact of the two programs on tuberculosis (TB) knowledge among participants.

DESIGN: A prospective, two-group site-randomized design conducted among 520 homeless adults residing in the Skid Row region of Los Angeles from 1998 to 2003, assessing completion rates of a 6-month isoniazid (INH) treatment program and change in TB knowledge.

RESULTS: Using intent-to-treat analysis, 62% of participants in the intervention program, compared with 39% of controls, completed the full 6-month course of LTBI treatment with INH. Logistic regression modeling revealed that intervention participants had three times greater odds of completing INH treatment than controls. TB knowledge improved in both programs, but the increase was greater among the intervention participants (P < 0.001).

CONCLUSIONS: Nurse case management combined with education, incentives, and tracking dramatically improves both adherence to LTBI treatment and TB knowledge in homeless persons compared to a standard approach of outreach and incentives.

Keywords: homeless adults; latent tuberculosis

Document Type: Regular Paper

Affiliations: 1: School of Nursing, University of California–Los Angeles (UCLA), Los Angeles, California, USA 2: David Geffen School of Medicine, UCLA, Los Angeles, California, USA 3: Division of Pulmonary and Critical Care, University of California–San Francisco, San Francisco, California, USA 4: John Wesley Community Health Center (JWCH) Medical Clinic at the Weingart Center, Los Angeles, California, USA 5: School of Nursing, University of California–Los Angeles (UCLA), Los Angeles, California, USA; and David Geffen School of Medicine, UCLA, Los Angeles, California, USA

Publication date: July 1, 2006

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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