TUBERCULOSIS--PREVENTION AND ADHERENCE INTERVENTIONS

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The number of new cases of tuberculosis in Los Angeles County has reached epidemic proportions. The incidence is almost three times the national rate and complicated by drug resistant strains. A major reason for this extremely high incidence is the lack of follow up of patients to assure completion of therapy. The long term objective of this research proposal is to identify cost-effective educational approaches which can be easily incorporated into the management and treatment of patients diagnosed as having active tuberculosis. Short-term objectives include 1) the identification of psychosocial and environmental determinants of adherence behavior and completion of therapy; and 2) to develop and test innovative educational strategies that enable health care professionals to target personal, social, and cultural barriers to adherence. The study population consists of individuals highly vulnerable to tuberculosis, including HIV-infected, immigrants, economically disadvantaged, and the homeless. A quasi-experimental four-group design in two Los Angeles County Health Centers will assess the independent and combined effects of educational counseling-E1, tangible incentives- E2, combination of counseling and incentives-E3, and compare program impact and outcome measures with a usual care control group, C4. A total of 300 patients (48% non-Hispanic Whites, 28% Hispanic, 14% Black and 10% Asian) in one study site will be randomly assigned to one of the three intervention groups and 150 patients in site 2 assigned to the usual care study group. Patients will be followed throughout their treatment program. Nurse health educators from the UCLA School of Nursing will interface with clinic staff, particularly the extended role nurse, in a multidisciplinary team approach. Cognitive, behavioral and biological outcome markers as well as cost-effectiveness analysis will be used to assess the effectiveness of the educational program.