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

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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.
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Keywords: adherence; compliance; hard-to-reach populations; indigenous leadership

Document Type: Research Article

Affiliations: 1: *School of Public Health, University of Illinois at Chicago, Chicago, Illinois 2: Independent Researcher, Seattle, Washington 3: Department of Health Studies, University of Chicago Chicago, Illinois, 4: §Georgia Perimeter College, Fairburn, Georgia 5: Chicago Department of Health, Chicago, Illinois 6: #Metro Public Health Department of Nashville/Davidson County, Nashville, Tennessee, USA

Publication date: 2015-03-01

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  • 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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