Efficacy of nurse case-managed intervention for latent tuberculosis among homeless subsamples.
BACKGROUND
The efficacy of a nurse case-managed intervention was evaluated in subsamples of participants with one of the following characteristics: female gender, African American ethnicity, recruited from a homeless shelter, a history of military service, lifetime injection drug use, daily alcohol and drug use, poor physical health, and a history of poor mental health.


OBJECTIVE
To determine whether a validated nurse case-managed intervention with incentives and tracking would improve adherence to latent tuberculosis infection treatment in subsamples of homeless persons with characteristics previously identified in the literature as predictive of nonadherence.


METHODS
A prospective 2-group site-randomized design was conducted with 520 homeless adults residing in 12 homeless shelters and residential recovery sites in the Skid Row region of Los Angeles from 1998 to 2003.


RESULTS
Daily drug users, participants with a history of injection drug use, daily alcohol users, and persons who were not of African American race or ethnicity had particularly poor completion rates, even in the nurse case-managed intervention program (48%, 55%, 54%, and 50%, respectively). However, the intervention achieved a 91% completion rate for homeless shelter residents and significantly improved latent tuberculosis infection treatment adherence in 9 of 12 subgroups tested (odds ratios = 2.51-10.41), including daily alcohol and drug users, when potential confounders were controlled using logistic regression analysis.


CONCLUSIONS
Nurse case management with incentives appears to be a good foundation for increasing adherence to 6-month isoniazid treatment in a variety of homeless subgroups and, in particular, for sheltered homeless populations. However, additional social-structural and environmental strategies are needed to address those at greatest risk of nonadherence.
Nyamathi
Adeline
A
Audrienne H. Moseley Endowed Chair in Community Health Research, School of Nursing, University of California, Los Angeles, CA 90095-1702, USA. anyamath@sonnet.ucla.edu
Nahid
Payam
P
Berg
Jill
J
Burrage
Joe
J
Christiani
Ashley
A
Aqtash
Salah
S
Morisky
Donald
D
Leake
Barbara
B
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D019090:Case Management / Q000458:organization & administration*; D005260:Female; D006703:Ill-Housed Persons; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D016015:Logistic Models; D015141:Los Angeles; D008603:Mental Health; D008875:Middle Aged; D010349:Patient Compliance; D012307:Risk Factors; D015819:Substance Abuse, Intravenous; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000451:nursing*
D000995:Antitubercular Agents; D007538:Isoniazid