Incentives and accessibility: a pilot study to promote adherence to TB prophylaxis in a high-risk community.
METHODS
A community-based directly observed preventive therapy (DOPT) program for treatment of latent tuberculosis infection among injection drug users (IDUs) in an inner-city neighborhood.


OBJECTIVE
To test adherence to a 6-month course of DOPT using cash incentives and an easily accessible neighborhood location.


METHODS
Street-recruited IDUs (N = 205) were screened for Mycobacterium tuberculosis (TB) infection using the Mantoux test and two controls. Subjects who had a purified protein derivative (PPD) reaction of > or =5 mm, were anergic, or had a history of a positive PPD received clinical evaluation at a community field site, provided in collaboration with the San Francisco Department of Public Health Tuberculosis Clinic. Twenty-eight subjects were considered appropriate candidates for prophylaxis with isoniazid, and 27 enrolled in the pilot study. Participants received twice-weekly DOPT at a community satellite office, with a $10 cash incentive at each visit.


RESULTS
The 6-month (26-week) regimen was completed by 24/27 (89%) participants. The median time to treatment completion was 27 weeks (range 26 to 34 weeks). The median proportion of dosing days attended in 6 months was 96%.


CONCLUSIONS
Community-based DOPT using cash incentives resulted in high levels of adherence and treatment completion among drug users.
Lorvick
J
J
Urban Health Study, University of California, San Francisco 94143-1304, USA. jbo@itsa.ucsf.edu
Thompson
S
S
Edlin
B R
BR
Kral
A H
AH
Lifson
A R
AR
Watters
J K
JK
D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D003153:Community Health Services; D004334:Drug Administration Schedule; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage; D008297:Male; D008403:Mass Screening; D010349:Patient Compliance; D010865:Pilot Projects; D012495:San Francisco; D015819:Substance Abuse, Intravenous; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000517:prevention & control*; D014504:Urban Health
D000995:Antitubercular Agents; D007538:Isoniazid