BACKGROUND: The efficacy of a nurse case-managed intervention was evaluated in subsamples of participants with one of the following characteristics: female gender, African American ethnicity, recruited from a homeless shelter, a history of military service, lifetime injection drug use, daily alcohol and drug use, poor physical health, and a history of poor mental health. OBJECTIVE: To determine whether a validated nurse case-managed intervention with incentives and tracking would improve adherence to latent tuberculosis infection treatment in subsamples of homeless persons with characteristics previously identified in the literature as predictive of nonadherence. METHODS: A prospective 2-group site-randomized design was conducted with 520 homeless adults residing in 12 homeless shelters and residential recovery sites in the Skid Row region of Los Angeles from 1998 to 2003. RESULTS:Daily drug users, participants with a history of injection drug use, daily alcohol users, and persons who were not of African American race or ethnicity had particularly poor completion rates, even in the nurse case-managed intervention program (48%, 55%, 54%, and 50%, respectively). However, the intervention achieved a 91% completion rate for homeless shelter residents and significantly improved latent tuberculosis infection treatment adherence in 9 of 12 subgroups tested (odds ratios = 2.51-10.41), including daily alcohol and drug users, when potential confounders were controlled using logistic regression analysis. DISCUSSION: Nurse case management with incentives appears to be a good foundation for increasing adherence to 6-month isoniazid treatment in a variety of homeless subgroups and, in particular, for sheltered homeless populations. However, additional social-structural and environmental strategies are needed to address those at greatest risk of nonadherence.
RCT Entities:
BACKGROUND: The efficacy of a nurse case-managed intervention was evaluated in subsamples of participants with one of the following characteristics: female gender, African American ethnicity, recruited from a homeless shelter, a history of military service, lifetime injection drug use, daily alcohol and drug use, poor physical health, and a history of poor mental health. OBJECTIVE: To determine whether a validated nurse case-managed intervention with incentives and tracking would improve adherence to latent tuberculosis infection treatment in subsamples of homeless persons with characteristics previously identified in the literature as predictive of nonadherence. METHODS: A prospective 2-group site-randomized design was conducted with 520 homeless adults residing in 12 homeless shelters and residential recovery sites in the Skid Row region of Los Angeles from 1998 to 2003. RESULTS: Daily drug users, participants with a history of injection drug use, daily alcohol users, and persons who were not of African American race or ethnicity had particularly poor completion rates, even in the nurse case-managed intervention program (48%, 55%, 54%, and 50%, respectively). However, the intervention achieved a 91% completion rate for homeless shelter residents and significantly improved latent tuberculosis infection treatment adherence in 9 of 12 subgroups tested (odds ratios = 2.51-10.41), including daily alcohol and drug users, when potential confounders were controlled using logistic regression analysis. DISCUSSION: Nurse case management with incentives appears to be a good foundation for increasing adherence to 6-month isoniazid treatment in a variety of homeless subgroups and, in particular, for sheltered homeless populations. However, additional social-structural and environmental strategies are needed to address those at greatest risk of nonadherence.
Authors: Steven L Batki; Valerie A Gruber; Julia Moon Bradley; Mark Bradley; Kevin Delucchi Journal: Drug Alcohol Depend Date: 2002-05-01 Impact factor: 4.492
Authors: H Davidson; N W Schluger; P H Feldman; D P Valentine; E E Telzak; F N Laufer Journal: Int J Tuberc Lung Dis Date: 2000-09 Impact factor: 2.373
Authors: J P Tulsky; J A Hahn; H L Long; D B Chambers; M J Robertson; M A Chesney; A R Moss Journal: Int J Tuberc Lung Dis Date: 2004-01 Impact factor: 2.373
Authors: Adeline Nyamathi; Benissa E Salem; David Farabee; Elizabeth Hall; Sheldon Zhang; Mary Marfisee; Farinaz Khalilifard; Stefanie Musto; Barbara Leake Journal: Addict Res Theory Date: 2014-12
Authors: Adeline Nyamathi; Steven Shoptaw; Allan Cohen; Barbara Greengold; Kamala Nyamathi; Mary Marfisee; Viviane de Castro; Farinaz Khalilifard; Daniel George; Barbara Leake Journal: Drug Alcohol Depend Date: 2010-02-01 Impact factor: 4.492
Authors: Adeline Nyamathi; Peggy Compton; Allan Cohen; Mary Marfisee; Steven Shoptaw; Barbara Greengold; Viviana de Castro; Mashid Reaves; Albert Hasson; Daniel George; Barbara Leake Journal: West J Nurs Res Date: 2009-01-07 Impact factor: 1.967