TUBERCULOSIS--PREVENTION AND ADHERENCE INTERVENTIONS

洛杉矶县新增肺结核病例已达 流行病的比例。 发病率几乎是全国的三倍 并伴有耐药菌株。 一个主要原因是 极高的发病率是缺乏对患者的随访，以确保 完成治疗。 本研究计划的长远目标 是确定具有成本效益的教育方法， 纳入被诊断为 患有活动性肺结核。短期目标包括：（1） 确定依从性的社会心理和环境决定因素 行为和完成治疗; 2）开发和测试创新 教育战略，使卫生保健专业人员的目标， 个人的、社会的和文化的障碍。 研究 人口由极易感染结核病的个体组成， 包括艾滋病毒感染者、移民、经济弱势群体， 无家可归 两个洛杉矶的准实验四组设计 县卫生中心将评估以下因素的独立和综合影响： 教育咨询-E1，有形激励- E2， 咨询和激励措施-E3，并比较计划的影响和结果 对照组采用常规护理措施，C4. 共300名患者 (48%非西班牙裔白人，28%西班牙裔，14%黑人和10%亚洲人） 研究中心将被随机分配至三种干预措施之一 研究中心2的150名患者被分配到常规护理研究组。 患者将在整个治疗计划中接受随访。 护士 来自加州大学洛杉矶分校护理学院的健康教育工作者将与 诊所工作人员，特别是扩展角色护士，在多学科 团队方法。 认知、行为和生物学结果标志物， 以及成本效益分析将用于评估 教育计划的有效性。

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.