Pilote L, Tulsky J P, Zolopa A R, Hahn J A, Schecter G F, Moss A R
Department of Epidemiology and Biostatistics, San Francisco General Hospital, University of California, USA.
Arch Intern Med. 1996 Jan 22;156(2):161-5.
Adherence to tuberculosis evaluation is poor in a high-risk population such as the homeless.
To test two interventions aimed at improving adherence to tuberculosis evaluation and to identify predictors of adherence.
We conducted a randomized clinical trial in shelters and food lines in the inner city of San Francisco, Calif. We randomized 244 eligible subjects infected with tuberculosis to (1) peer health adviser (assistance by a peer [n = 83]), (2) monetary incentive ($5 payment [n = 82]), or (3) usual care (referral slips and bus tokens only [n = 79]). The primary outcome of the study was adherence to a first follow-up appointment at the tuberculosis clinic, where subjects were evaluated for active tuberculosis and the need for isoniazid prophylaxis.
Of the subjects assigned to a monetary incentive, 69 (84%) completed their first follow-up appointment, compared with 62 subjects (75%) assigned to a peer health adviser and 42 subjects (53%) assigned to usual care. Adherence was higher in the monetary incentive and peer health adviser groups than in the usual care group (P < .001 and P = .004, respectively). Patients not using intravenous drugs and patients 50 years of age or older were more likely to adhere to a first follow-up appointment (odds ratios [95% confidence intervals], 2.5 [1.3 to 5.0] and 3.3 [1.2 to 8.8], respectively). Among the 173 tuberculosis-infected subjects who completed their appointment, isoniazid therapy was started for 72 individuals, and three cases of active tuberculosis were identified.
A monetary incentive or a peer health adviser is effective in improving adherence to a first follow-up appointment in homeless individuals infected with tuberculosis. A monetary incentive appears to be superior. Intravenous drug users and young individuals are at high risk for poor adherence to referral.
在无家可归者等高危人群中，对结核病评估的依从性较差。
测试两种旨在提高结核病评估依从性的干预措施，并确定依从性的预测因素。
我们在加利福尼亚州旧金山市中心的收容所和食品供应线进行了一项随机临床试验。我们将244名符合条件的结核病感染受试者随机分为：（1）同伴健康顾问组（由同伴提供协助[n = 83]），（2）金钱激励组（支付5美元[n = 82]），或（3）常规护理组（仅提供转诊单和公交代币[n = 79]）。该研究的主要结局是在结核病诊所进行首次随访预约的依从性，在该诊所对受试者进行活动性结核病评估以及是否需要预防性使用异烟肼。
在分配到金钱激励组的受试者中，69名（84%）完成了首次随访预约，相比之下，分配到同伴健康顾问组的62名受试者（75%）以及分配到常规护理组的42名受试者（53%）。金钱激励组和同伴健康顾问组的依从性高于常规护理组（分别为P <.001和P =.004）。不使用静脉注射药物的患者以及50岁及以上的患者更有可能坚持首次随访预约（优势比[95%置信区间]分别为2.5[1.3至5.0]和3.3[1.2至8.8]）。在173名完成预约的结核病感染受试者中，72人开始接受异烟肼治疗，发现了3例活动性结核病病例。
金钱激励或同伴健康顾问在提高感染结核病的无家可归者首次随访预约的依从性方面有效。金钱激励似乎更具优势。静脉注射药物使用者和年轻人依从转诊的风险较高。
