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1st appeared
21
March 2000
Cash Incentives Improve TB Prevention Among Homeless Homeless adults who were offered a small cash incentive to undergo preventive therapy for tuberculosis completed the treatment at nearly double the rate of others, according to new research by a UCSF team. All study participants were from San Francisco and tested positive to a tuberculin skin test, indicating they had been exposed to TB. Participants did not yet have active contagious TB, and preventive therapy would keep them from getting sicker and becoming contagious.
The cash incentive was $5 per visit for therapy, which consisted of the antibiotic isoniazid, known as INH, administered in pill form on a regular basis over a six-month period. "Our study findings indicate that there is a role for appropriate monetary incentives in TB control. From previous studies we know that the US homeless population is at high risk for TB infection and that adherence to preventive therapy is difficult within this group," said Jacqueline Peterson Tulsky, MD, lead investigator of the research team and UCSF associate clinical professor of medicine. Research results were reported in March 13 of the Archives of Internal Medicine. A specialist in TB and HIV/AIDS care, Tulsky treats patients at San Francisco General Hospital Medical Center. INH is a well-established tool for TB control, and previous research has shown that adherence is higher -- even in hard to treat populations with active TB -- when patients are observed taking each dose of preventive medication, rather than when they take it solely on their own. The approach is known as directly observed preventive therapy, or DOPT. The study involved 118 persons who were randomized into one of three groups:
Study results showed that 44 percent of participants in the monetary incentive DOPT arm completed the six-month INH therapy. This compared with a completion rate of 19 percent in the peer health adviser DOPT group and 26 percent in the usual care group. The low rate of adherence in the peer health adviser arm was a surprise to the research team, Tulsky said, because this strategy was developed with the idea that peer outreach workers have been used in other health care activities successfully and the homeless peers seemed well-suited to understand the problems of the homeless participants. Follow-up discussion found that many of the advisers felt they lacked some of the communication and life skills necessary for effectively dealing with study participants. "From this finding, we realized that although it was an appealing idea to employ homeless adults to work with their peers, we need to develop a more extensive preparatory program--combining both support and training -- in order for it to be effective." Tulsky said.
Some health care providers feel that it is inappropriate to give money to persons with known alcohol or drug addictions, Tulsky noted, but the goal of this study was to openly review the role of different types of clinical approaches for preventive TB therapy. "From our findings, we feel that a $5 incentive provides a positive effect at both the public health and personal levels and should be considered by jurisdictions with large numbers of TB cases among their homeless." Links: Study Links Decline in San Francisco's TB Rates to Intensified Control Programs Source: Corinna Kaarlela, News Services |
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