Tulsky J P, Hahn J A, Long H L, Chambers D B, Robertson M J, Chesney M A, Moss A R
Department of Medicine, Positive Health Program, San Francisco General Hospital, University of California, San Francisco, San Francisco, California 94110, USA.
Int J Tuberc Lung Dis. 2004 Jan;8(1):83-91.
Community-based population of homeless adults living in San Francisco, California.
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.
Prospective, randomized clinical trial comparing a 5 dollar cash or a 5 dollar 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.
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.
Simple, low cost incentives can be used to improve adherence to TB preventive therapy in indigent adults.
以加利福尼亚州旧金山的无家可归成年人为基础的社区人群。
比较现金激励和非现金激励对1）潜伏性结核感染治疗依从性，以及2）寻找错过服药剂量参与者所需时间的影响。
前瞻性随机临床试验，比较5美元现金激励或5美元非现金激励。所有参与者均接受直接观察下的预防性治疗，并按照预定方案进行标准化随访。测量完成率和随访参与者所需的时间。
119名参与者中，102名（86%）完成了治疗。现金组和非现金组之间没有差异。男性（比值比5.65，95%可信区间1.36 - 23.40，P = 0.02）以及研究开始时居住在稳定住房中的人（比值比4.86，95%可信区间1.32 - 17.94，P = 0.02）的完成率显著更高。物质使用或心理健康指标与完成情况无关。与非现金组相比，现金组参与者完成治疗所需的随访显著更少（P = 0.03）。在多变量分析中，非现金激励、使用快克可卡因以及既往未接受预防性治疗与更多的随访时间相关。
简单、低成本的激励措施可用于提高贫困成年人对结核病预防性治疗的依从性。
