TUBERCULOSIS--PREVENTION AND ADHERENCE INTERVENTIONS

洛杉矶县新增肺结核病例已达 流行比例。发病率几乎是全国的三倍 耐药率高，并伴有耐药菌株。造成这种情况的一个主要原因 发病率极高的是缺乏对患者的随访保证 完成治疗。这项研究计划的长期目标是 是找出经济高效的教育方法，这些方法可以很容易地 纳入对被诊断为 患有活动性肺结核的。短期目标包括1) 确定依从性的心理社会和环境决定因素 行为和完成治疗；以及2)开发和测试创新 教育战略，使卫生保健专业人员能够针对 坚持的个人、社会和文化障碍。这项研究 人口由极易患结核病的个人组成， 包括艾滋病毒感染者、移民、经济弱势群体和 无家可归。两个洛杉矶的准试验性四组设计 县卫生中心将评估独立的和综合的影响 教育咨询-E1，有形激励-E2，组合 咨询和激励-E3，并比较计划的影响和结果 措施与常规护理对照组，C4。总共有300名患者 (非西班牙裔白人48%，西班牙裔28%，黑人14%，亚裔10%) 研究地点将被随机分配到三种干预措施之一 组和150名患者在站点2被分配到常规护理研究组。 患者将在整个治疗过程中接受跟踪。护士 加州大学洛杉矶分校护理学院的健康教育者将与 诊所工作人员，特别是多学科中的扩展角色护士 团队合作。认知、行为和生物结果标记为 以及成本效益分析将用于评估 教育项目的有效性。

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.