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

• Published in: The international journal of tuberculosis and lung disease Vol. 8; no. 1; pp. 83 - 91
• Main Authors: TULSKY, J. P, HAHN, J. A, LONG, H. L, CHAMBERS, D. B, ROBERTSON, M. J, CHESNEY, M. A, MOSS, A. R
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01-01-2004; Union internationale contre la tuberculose et les maladies respiratoires
• Subjects: Adult; Antitubercular Agents - administration & dosage; Bacterial diseases; Biological and medical sciences; California; Confidence Intervals; Female; Homeless; Homeless Persons - statistics & numerical data; Human bacterial diseases; Humans; Incentives; Infectious diseases; Latent Tuberculosis Infection; Logistic Models; Male; Medical sciences; Middle Aged; Motivation; Odds Ratio; Patient Compliance - statistics & numerical data; Patient Selection; Poverty; Probability; Prospective Studies; Randomized Trial; Reference Values; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Statistics, Nonparametric; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis and atypical mycobacterial infections; Urban Population; California; Human; Incentive; randomized trial; Mycobacterial infection; Adhesion; Infection; Prevention; Latent; Randomization; Homeless; incentives; Tuberculosis; Bacteriosis; latent tuberculosis infection; Adult
• ISSN: 1027-3719; 1815-7920

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.